Teaching NeuroImages: Mucormycosis-associated vasculitis

Feitoza, Laisson de Moura; Altemani, Albina; Silva, Nivaldo Adolfo da; Reis, Fabiano

doi:10.1212/wnl.0000000000007275

Cited by 10 publications

(2 citation statements)

References 2 publications

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“…Vascular invasion causing thrombosis of the cavernous segment of the internal carotid artery is the common event causing cerebral infarcts. The invasion of vessel is seen as arterial wall enhancement in post-contrast images [ 17 ]. Facial, orbital fat stranding, and retro-antral soft tissue extension are the early indicators of the aggressive course of the disease [ 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Radiological Manifestations of Rhino-Orbito-Cranial Mucormycosis in COVID-19 Patients Correlated With Pathological and Clinical Outcomes and Emphasis on Magnetic Resonance Imaging-Based Scoring System

Patil¹,

Kumar²,

Battula³

et al. 2023

Cureus

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There was tremendous increase in the number of cases of mucormycosis among patients affected by coronavirus disease 2019 during the second wave of pandemic in South Asian countries. This invasive fungal infection primarily affects paranasal sinuses and can have orbito-facial and intracranial extension. We are presenting the radiological findings of invasive mucormycosis with pathological and clinical outcome correlation. It is important for radiologists to have the knowledge of various presentations of this opportunistic infection for early diagnosis and helping clinicians in planning the appropriate line of management. The study also emphasizes on the correlation between the extent of involvement with clinical outcome and we proposed a magnetic resonance imaging (MRI) based scoring system to standardize and prognosticate the patients affected with mucormycosis.Materials and methods: We utilized GE 1.5 tesla, 16-channeled MRI machine for scanning the clinically suspected mucormycosis patients and did plain and contrast study of the paranasal sinuses, orbito-facial study and included brain as and when required. Images were acquired in axial, coronal, and sagittal planes using T1, T2, and fat-saturated short tau inversion recovery sequences (STIR), fat-saturated contrast sequences for better evaluation of the extent of the disease. Diffusion-weighted sequence was also acquired to detect ischemic changes in optic nerve or brain parenchyma. Contrast study was used to detect any major vessel occlusion or cavernous sinus thrombosis in the study population.Results: Total number of cases (n) included in the study were 32. The mean age group was 41-50 years with the median age was 47 years. Out of 32 cases (n=32), in 16 cases (50%) the disease was limited only to the paranasal sinuses and in remaining 16 (50%) cases, disease has spread to other regions such as orbits, facial soft tissues, optic nerve, and brain parenchyma. All the 18 cases with Mild score (MRI ROCM score 1-3) survived and all those with severe score (2 cases) (MRI ROCM score 7-10) did not survive. Conclusion:During the second wave of COVID-19 pandemic, we observed a significant rise in acute invasive mucormycosis infection primarily involving the paranasal sinuses and spread to orbito-facial, cerebral parenchyma causing related complications and hence increased morbidity and death. Radiologically, using MRI, it was effectively possible to detect early extrasinonasal spread and other fatal complications thereby guiding the physicians and surgeons in the proper early aggressive management of the disease. Here, we have described the radiological characteristics of paranasal sinus mucormycosis and its spread to other regions. We also proposed an MRI-based Scoring System for standardized assessment of the disease severity. We observed in our study that the extent of disease on MRI is directly correlating with mortality.

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Section: Discussionmentioning

confidence: 99%

Radiological Manifestations of Rhino-Orbito-Cranial Mucormycosis in COVID-19 Patients Correlated With Pathological and Clinical Outcomes and Emphasis on Magnetic Resonance Imaging-Based Scoring System

Patil¹,

Kumar²,

Battula³

et al. 2023

Cureus

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“…Notably, enhancement may be absent in areas of devitalized tissue, both in the sinonasal mucosa (the ‘black turbinate’ sign) and surrounding soft tissues. In such cases, vascular involvement is frequently observed, and the use of high-resolution vessel wall MRI is valuable in characterizing vasculitis by demonstrating an enhancement of the vascular wall in the areas of inflammation [ 105 ].…”

Section: Skull Base Tumor Mimics: Developmental Lesions Anatomic Vari...mentioning

confidence: 99%

Imaging of Skull Base Tumors

Battal

Zamora

2023

Tomography

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The skull base provides a platform for supporting the brain while serving as a conduit for major neurovascular structures. In addition to malignant lesions originating in the skull base, there are many benign entities and developmental variants that may simulate disease. Therefore, a basic understanding of the relevant embryology is essential. Lesions centered in the skull base can extend to the adjacent intracranial and extracranial compartments; conversely, the skull base can be secondarily involved by primary extracranial and intracranial disease. CT and MRI are the mainstay imaging methods and are complementary in the evaluation of skull base lesions. Advances in cross-sectional imaging have been crucial in the management of patients with skull base pathology, as this represents a complex anatomical area that is hidden from direct clinical exam. Furthermore, the clinician must rely on imaging studies for therapy planning and to monitor treatment response. It is crucial to have a thorough understanding of skull base anatomy and its various pathologies, as well as to recognize the appearance of treatment-related changes. In this review, we aim to describe skull base tumors and tumor-like lesions in an anatomical compartmental approach and present imaging methods that aid in diagnosis, management, and follow-up.

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