MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis

Sehgal, Apoorva; Kumar, Jyoti; Garg, Anju; Jain, Ayush; Meher, Ravi; Singh, Meeta; Goel, Ruchi

doi:10.1016/j.ejrad.2022.110341

Cited by 5 publications

(7 citation statements)

References 31 publications

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“…Mucosal thickening with T2 hypointensity should, however, raise suspicion for ROM [10 ▪▪ ]. Sino-nasal involvement can also present with variable intensities on T1-weighted (T1W) and T2-weighted (T2W) MR images due to fungal elements [10 ▪▪ ,22 ▪ ]. Middlebrooks et al [23] generated a seven-variable diagnostic model for acute invasive fungal rhino sinusitis (including periantral fat, pterygopalatine fossa, nasolacrimal duct, lacrimal sac, bone dehiscence, orbital invasion, and septal ulceration) which showed 95% sensitivity and 86% specificity with the involvement of one variable.…”

Section: Radiological Manifestationsmentioning

confidence: 99%

“…Pathways to the orbits include anterior and posterior ethmoidal foramina along the medial orbital wall, nasolacrimal duct along the inferomedial wall, infra-orbital foramen along the floor, and inferior orbital fissure along the inferolateral wall [4 ▪ ,22 ▪ ]. Early orbital infection can be seen with stranding soft-tissue infiltration or abscess and edema of the retroorbital fat along the medial orbital wall, which is best depicted on fat-saturated T2W images [10 ▪▪ ,22 ▪ ]. Orbital invasion can also be characterized by proptosis and hyperintensity of orbital fat and extraocular muscles on T2W images [18].…”

Section: Radiological Manifestationsmentioning

confidence: 99%

“…Optic nerve infarction can also be seen as a high-signal intensity on DWI [10 ▪▪ ]. Optic nerve involvement in ROM can appear as thickening with an enhancement of the optic nerve sheath; rarely, a prechiasmatic optic nerve abscess can appear as a bulky disease with peripheral enhancement, diffusion restriction, and central liquefaction [22 ▪ ]. Furthermore, orbital apex syndrome can be observed when enhancing soft tissue extends to the optic canal and superior orbital fissure [10 ▪▪ ].…”

Section: Radiological Manifestationsmentioning

confidence: 99%

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Rhino-orbital mucormycosis

Ryu

Laylani

Davila-Siliezar

et al. 2022

Current Opinion in Ophthalmology

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Purpose of reviewThe current article will update and review the clinical and radiological manifestations and management of rhino-orbital mucormycosis (ROM).Recent findingsThere has been an increase in cases of ROM worldwide, especially in India. Immunosuppression (especially diabetes mellitus) is a known predisposing risk factor for ROM. Delayed diagnosis and treatment of ROM can be vision or life-threatening. This article reviews the clinical and radiologic features, treatment, and prognosis of ROM with special emphasis on new and emerging therapies.SummaryROM is an angioinvasive fungal infection that affects the sinuses and orbits and may present to ophthalmologists. Clinicians should have a high index of suspicion for ROM, especially in patients with poorly controlled diabetes mellitus or other immunosuppression. Corticosteroid treatment (including the recent COVID-19 pandemic) may be a predisposing risk factor for ROM.

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Section: Radiological Manifestationsmentioning

confidence: 99%

Section: Radiological Manifestationsmentioning

confidence: 99%

Section: Radiological Manifestationsmentioning

confidence: 99%

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Rhino-orbital mucormycosis

Ryu

Laylani

Davila-Siliezar

et al. 2022

Current Opinion in Ophthalmology

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“…Acute neurological symptoms range from mild sensory impairment such as anosmia or ageusia, impaired cognition, agitation, fatigue, insomnia, and headache to more severe neurological conditions like cranial nerve palsies, ataxia, neuralgia, corticospinal tract signs, encephalitis, cerebral venous thrombosis, seizures, Guillain-Barré syndrome, and stroke [ 10 ]. Moreover, immunocompromised youth and children with comorbid conditions are predisposed to severe SARS-CoV-2 infection, including synergistic fungal central nervous system infections [ 11 , 12 ]. Here, we report the clinical course and outcome of a 13-year-old previously healthy, COVID-19-vaccinated adolescent who developed a frontal brain abscess leading to life-threatening intracranial hypertension requiring abscess drainage and subsequent decompressive craniectomy after recent SARS-CoV-2 infection.…”

Section: Introductionmentioning

confidence: 99%

Bacterial Brain Abscess and Life-Threatening Intracranial Hypertension Requiring Emergent Decompressive Craniectomy After SARS-CoV-2 Infection in a Healthy Adolescent

Kunapaisal¹,

Guo²,

Gomez³

et al. 2023

Cureus

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Acute coronavirus 2 (SARS-CoV-2) infection usually results in mild symptoms, but secondary infections after SARS-CoV-2 infection can occur, particularly with comorbid conditions. We present the clinical course of a healthy adolescent with a brain abscess and life-threatening intracranial hypertension requiring emergent decompressive craniectomy after a SARS-CoV-2 infection. A 13-year-old healthy immunized male presented with invasive frontal, ethmoid, and maxillary sinusitis and symptoms of lethargy, nausea, headache, and photophobia due to a frontal brain abscess diagnosed three weeks after symptoms and 11 days of oral amoxicillin treatment. Coronavirus disease 2019 (COVID-19) reverse transcription-polymerase chain reaction (RT-PCR) was negative twice but then positive on amoxicillin day 11 (symptom day 21), when magnetic resonance imaging revealed a 2.5-cm right frontal brain abscess with a 10-mm midline shift. The patient underwent emergent craniotomy for right frontal epidural abscess washout and functional endoscopic sinus surgery with ethmoidectomy. On a postoperative day one, his neurological condition showed new right-sided pupillary dilation and decreased responsiveness. His vital signs showed bradycardia and systolic hypertension. He underwent an emergent decompressive craniectomy for signs of brain herniation. Bacterial PCR was positive for Streptococcus intermedius, for which he received intravenous vancomycin and metronidazole. He was discharged home on hospital day 14 without neurological sequelae and future bone flap replacement. Our case highlights the importance of timely recognition and treatment of brain abscess and brain herniation in patients with neurological symptoms after SARS-CoV-2 infection, even in otherwise healthy patients.

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“…Few studies have described imaging features of COVID-19associated AIFR. 10,[13][14][15][16][17][18][19] We have described imaging findings in 90 studies including computed tomography (CT) and magnetic resonance imaging (MRI) of 60 patients of post-COVID-19 AIFR admitted and managed at our institute.…”

Section: Introductionmentioning

confidence: 99%

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

Yadav

Kumar

Sachdeva

et al. 2023

Indian Journal of Neurosurgery

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Background Acute invasive fungal rhinosinusitis (AIFR) is a rare, rapidly progressive, and life-threatening infection involving the nasal cavity and paranasal sinuses. Purpose of this study is to describe imaging features of coronavirus disease-2019 (COVID-19)-associated AIFR. Methods This was a retrospective observational study. Inclusion criteria: (1) post-COVID-19 patients with fungal rhinosinusitis detected on potassium hydroxide smear or histopathology; (2) onset of symptoms (facial pain, dental pain, facial swelling or discoloration, nasal bleed, periorbital swelling, ptosis, redness of eyes, vision loss) less than 4 weeks; and (3) magnetic resonance imaging/computed tomography (MRI/CT) done within 5 days before surgery. Exclusion criteria: (1) cases of sinusitis without a history of previous COVID-19 infection; and (2) cases in whom fungal hyphae were not demonstrated on pathological examination. Noncontrast CT and dedicated MRI sequences were done initially. Site of involvement, unilateral/bilateral involvement, pattern of mucosal thickening, enhancement pattern, periantral invasion, orbital invasion, intracranial involvement, perineural spread, vascular involvement, and bony involvement were recorded. CT and MRI imaging features were compared. Results Analysis of 90 studies (CT and MRI) in 60 patients was done. Most common site of involvement was ethmoid followed by maxillary sinus. Bilateral disease was more common. Mucosal thickening with T2 hypointense septations was seen in 88.4% MRI studies. Periantral and orbital involvement was seen, respectively, in 84.6% and 55.7% cases of MRI. Intracranial involvement was noted in form of meningitis, cerebritis, abscess, infarct, hemorrhage, cavernous sinus, or perineural invasion. Vascular involvement was noted in form of vascular occlusion (n = 3), vascular narrowing (n = 3), and pseudoaneurysm (n = 2). MRI was more sensitive in detecting periantral invasion, deep infratemporal fossa, cavernous sinus involvement, perineural invasion, optic nerve involvement, and vascular occlusion and narrowing, while CT was superior in identification of bony erosions. Conclusion Early recognition of AIFR in post-COVID-19 patients is important to prevent disease-related morbidity/mortality. Several rarely described findings are noted in our series of AIFR, like optic nerve involvement, pituitary fungal abscess, perineural spread, fungal aneurysms, and arteritis-related posterior circulation infarcts. MRI is superior for early detection of disease and in estimation of extent of disease, compared with CT. Imaging can help in early detection of AIFR, which has a significant impact on patient outcome.

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MR imaging spectrum in COVID associated Rhino-Orbito-Cerebral mucormycosis with special emphasis on intracranial disease and impact on patient prognosis

Cited by 5 publications

References 31 publications

Rhino-orbital mucormycosis

Rhino-orbital mucormycosis

Bacterial Brain Abscess and Life-Threatening Intracranial Hypertension Requiring Emergent Decompressive Craniectomy After SARS-CoV-2 Infection in a Healthy Adolescent

Imaging Features of COVID-19-Associated Acute Invasive Fungal Rhinosinusitis

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