Neuroradiological profile of Rhinoorbitocerebral mucormycosis in COVID-19 pandemic

Objective: To study the radiological presentations of mucormycosis in the study cohorts.The patients were categorized as COVID-19 and diabetes millitus;COVID-19 and non-Diabetes;Non COVID-19 and non-diabetes and these cohorts were analysed. Background: There has been a recent surge of mucormycosis with COVID 19 infection particularly in patients with diabetes.Multicompartmental and extrasinonasal tissue infarction is possible without overt bone involvement and caused by the dissemination of fungal elements from the nasal cavity via perineural and perivascular routes.Fungal vasculitis results in internal carotid artery occlusion and cerebral infarction.Imaging features reflect the angioinvasive behavior of the Mucoraceae family, which cause necrotizing vasculitis and thrombosis resulting in extensive tissue infarction. Design/Methods: This was a Prospective observational study of Rhinoorbitocerebral mucormycosis cases presenting from May to July 2021 to our hospital.The clinical examination findings and neuroimaging features were assessed among the study cohorts. Results: Of the 544 patients the mean age of patients was 51.9 years with a male preponderance (71%).Uncontrolled hyperglycemia was present in 90% of all patients.Ethmoid sinus was the most common paranasal sinus involved by imaging( 86%).The most common site of extrasinus involvement was orbit (76%) and face (57%), followed by orbital apex, masticator space,pterygopalatine fossa.Intracranial extension with involvement of cavernous sinus was seen in 34% of patients, brain abscess(19.2%),internal carotid artery(17%),brain infarction(45.2%),meningeal thickening and enhancement(29.2%),bone and skull base(14%).The most common neuroradiological presentation seen in all cohorts was cavernous sinus thrombosis.The propensity for multiple cerebral abscess and skull base osteomyelitis was more in patients of Rhinoorbitocerebral mucormycosis with diabetes and COVID-19 cohort.Internal carotid artery involvement was predominantly seen in COVID-19 and non diabetic cohort.Limited sinonasal disease was more commonly seen in Non-COVID-19 and diabetes patients of mucormycosis Conclusions: Central to early diagnosis is a high index of suspicion by the clinician and the radiologist.The cavernous sinus was the most common site of intracranial involvement in our study.

Acute monocular vision loss as presenting symptom of delayed stroke from internal carotid occlusion in COVID-19.

Covid-19 infection has been declared a pandemic by the World Health Organization. We present a unique case of a middle-aged gentleman, who recovered from asymptomatic Covid-19 infection and presented again with delayed stroke. He had vision loss secondary to internal carotid artery occlusion in the absence of neurological symptoms. To the best of our knowledge, this is the first case that describes cerebrovascular stroke due to delayed large vessel occlusion secondary to Covid-19 infection presenting as monocular vision loss.