Rhino-orbito-cerebral Mucormycosis Complicated with Intracranial Hemorrhage

J Korean Neurol Assoc > Volume 18(2); 2000 > Article

Journal of the Korean Neurological Association 2000;18(2): 235-239.

두개내 출혈이 합병된 비-안와-대뇌 뮤코르진균증(모균병)

백기훈, 황성희이최휘철이신준현이이병철

한림대학교 의과대학 신경과학교실

Rhino-orbito-cerebral Mucormycosis Complicated with Intracranial Hemorrhage

Ki-Hoon Baek, M.D., Sung-Hee Hwang, M.D., Hwi-Chul Choi, M.D., Joon-Hyun Shin, M.D., Byung-Chul Lee, M.D.

Department of Neurology, Hallym University College of Medicine

Abstract

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hem-orrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemor-rhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was estab-lished, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hem-orrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A patho-logical examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the sur- ounding tissues. J Korean Neurol Assoc 18(2):235~239, 2000 Key Words : Rhino-orbito-cerebral mucormycosis, Diabetes mellitus, Arteritis, Intracranial hemorrhage