A Successful Combined Endovascular and Surgical Treatment of a Cranial Base Mucormycosis With an Associated Internal Carotid Artery Pseudoaneurysm

Alvernia, Jorge E.; Patel, Raf; Cai, David Z.; Dang, Nguyen Dinh; Anderson, Dwayne; Melgar, Miguel

doi:10.1227/01.neu.0000351773.74034.5e

Cited by 28 publications

(24 citation statements)

References 22 publications

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“…However, this patient had an unusual presentation, as parotid involvement due to zygomycosis has only been described once previously 5. Her inflammatory vasculitis and ensuing strokes from involvement of the carotid artery are recognized complications of zygomycosis, and in 1 case series of 41 patients with rhinocerebral mucormycosis, carotid involvement was seen in 31% of patients 6. After the punch biopsy of the patient's pinna showing nonseptated hyphae “reminiscent” of Mucor , why did her physicians delay administering amphotericin?…”

Section: Commentarymentioning

confidence: 79%

“Different strokes for different folks”

Wallace

Douglas

Safdar

et al. 2012

Journal of Hospital Medicine

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The approach to clinical conundrums by an expert clinician is revealed through the presentation of an actual patient's case in an approach typical of a morning report. Similarly to patient care, sequential pieces of information are provided to the clinician, who is unfamiliar with the case. The focus is on the thought processes of both the clinical team caring for the patient and the discussant. A 35-year-old woman presented to her primary care physician complaining of left post-auricular pain, swelling, and redness. She described the pain as 8 out of 10, constant, sharp, and nonradiating. She denied fever or chills. A presumptive diagnosis of cellulitis led to a prescription for oral trimethoprim-sulfamethoxazole. Left facial swelling worsened despite 4 days of antibiotics, so she came to the emergency department.Noninfectious causes of this woman's symptoms include trauma, or an inflammatory condition such as polychondritis. Key infectious considerations are mastoiditis or a mastoid abscess. Herpes zoster with involvement of the pinna and auditory canal may also present with pain and redness. In the absence of findings suggestive of an infection arising from the auditory canal, cellulitis is a reasonable consideration. With the growing incidence of community-acquired methicillin-resistant Staphylococcus aureus infections, an agent effective against this pathogen such as trimethoprim-sulfamethoxazole may be used, usually in combination with an antibiotic that provides more reliable coverage for group A streptococcus.Her past medical history included poorly controlled type II diabetes mellitus and asthma. She reported no previous surgical history. Her current medications were insulin, albuterol inhaler, and trimethoprim-sulfamethoxazole, although she had a history of noncompliance with her insulin. She was married with 1 child and was unemployed. She smoked 1 pack of cigarettes daily, drank up to 6 beers daily, and denied use of illicit drugs.Her history of diabetes increases her risk of malignant otitis externa. Both diabetes and excess alcohol consumption are risk factors for herpes zoster. Smoking has been shown to increase the risk of otitis media and carriage by S. pneumoniae, a common pathogen in ear infections.She was ill-appearing and in moderate respiratory distress. Her temperature was 39 C, blood pressure 149/93 mmHg, pulse 95 beats per minute, respiratory rate of 26 times per minute, with an oxygen saturation of 96% while breathing ambient air.She had swelling of the left side of the face extending to the left forehead and lateral neck. Examination of the external ear and auditory canal were unremarkable. The swelling had no associated erythema, tenderness, or lymphadenopathy. She had no oropharyngeal or nasal ulcers present. Her pupils were equal, round, and reactive to light and accommodation with normal sclera. Her trachea was midline; thyroid exam was normal. The heart sounds included normal S1 and S2 without murmurs, rubs, or gallops. Her lung exam was remarkable for inspiratory stridor. The abd...

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Section: Commentarymentioning

confidence: 79%

“Different strokes for different folks”

Wallace

Douglas

Safdar

et al. 2012

Journal of Hospital Medicine

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“…With development and gradual perfection in recent years, endovascular interventional therapy has been gradually taking the place of the traditional treatment methods for TICAP by virtue of its microtrauma and high recovery rate. This technique is the treatment of choice for TICAP; balloons and covered stents are frequently-used embolising materials (1)(2)(3)13,19,20).…”

Section: Resultsmentioning

confidence: 99%

Diagnosis and treatment of traumatic internal carotid artery pseudoaneurysm primarily manifested by repeated epistaxis

Chen¹,

Li²,

Xu³

et al. 2012

Turkish Neurosurgery

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AIm:The current study aims to explore the diagnosis and treatment of traumatic internal carotid artery pseudoaneurysm (TICAP) primarily manifested by repeated epistaxis. mAterIAl and methOds: Clinical data from 31 patients suffering from repeated epistaxis after trauma were retrospectively analyzed. All patients were diagnosed definitely with pseudoaneurysm at the internal carotid cavernous sinus segment by digital subtract angiography (DSA).results: Endovascular interventional therapy was performed for all the patients. 20 patients received direct occlusion of the parent artery by embolization with detachable balloons and the rest received covered stent implantation to cover the parent arterial tear. No death occurred. Epistaxis did not recur after operation.COnClusIOn: DSA is the gold standard for TICAP diagnosis. Endovascular interventional therapy is the treatment of choice for TICAP. Compared with internal carotid artery occlusion with balloons, covered stent implantation is a more valuable endovascular intervention method.KeywOrds: Epistaxis, Pseudoaneurysm, Traumatic, Angiography, Interventional therapy ÖZ AmAÇ: Bu çalışma temel olarak tekrarlanan epistaksisle ortaya çıkan travmatik internal karotid arter psödoanevrizmasının (TİKAP) tanı ve tedavisini incelemeyi amaçlamaktadır. yÖntem ve GereÇler: Travma sonrasında tekrarlanan epistaksisi olan 31 hastanın klinik verileri retrospektif olarak analiz edildi. Tüm hastalara dijital subtraksiyon anjiyografisi (DSA) yoluyla internal karotid kavernöz sinüs segmentinde psödoanevrizma şeklinde kesin tanı kondu. BulGulAr:Endovasküler girişimsel tedavi tüm hastalarda yapıldı. 20 hastada ayrılabilir balonlarla embolizasyon yoluyla ana arterde doğrudan oklüzyon yapılırken diğerlerinde ana arteriyel yırtığı örtmek üzere örtülü stent implantasyonu yapıldı. Herhangi bir ölüm olmadı. Ameliyattan sonra epistaksis tekrarlamadı. sOnuÇ: TİKAP tanısı için altın standart DSA'dır. Endovasküler girişimsel tedavi TİKAP için tercih edilen tedavidir. Balonlarla yapılan internal karotid arter oklüzyonuyla karşılaştırıldığında, örtülü stent implantasyonu daha değerli bir endovasküler girişim yöntemidir.

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“…Intracranial findings include infarcts related to vascular thrombosis, mycotic emboli, and frontal lobe abscesses [172,173]. Alvernia et al reported a case of internal carotid artery pseudoaneurysm owing to skull base mucormycosis [174]. Additionally, Delbrouck and co-authors presented a patient with a carotid artery occlusion due to fulminant rhinocerebral mucormycosis [175].…”

Section: Mucormycosismentioning

confidence: 99%

“…Amphotericin B is the drug of choice for treatment of mucormycosis and is recommended that therapy should be started as soon as the diagnosis is confirmed. Hyperbaric oxygen therapy can also be given as adjuvant [174].…”

Section: Mucormycosismentioning

confidence: 99%

Cranial Osteomyelitis

Akhaddar¹

2016

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A Successful Combined Endovascular and Surgical Treatment of a Cranial Base Mucormycosis With an Associated Internal Carotid Artery Pseudoaneurysm

Cited by 28 publications

References 22 publications

“Different strokes for different folks”

“Different strokes for different folks”

Diagnosis and treatment of traumatic internal carotid artery pseudoaneurysm primarily manifested by repeated epistaxis

Cranial Osteomyelitis

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