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A 48 year old man with acute lymphoblastic leukaemia and receiving treatment with amphotericin for pulmonary mucormycosis presented with an acute confusional state. On examination, the patient was febrile and there was a right homonymous hemianopia and mild word finding difficulty. Contrast enhanced CT showed a peripherally enhancing area of infarction within the left occipital and medial temporal lobes with entrapment of the left temporal horn (figure, top left). Three dimensional time of flight MR angiography showed occlusion of the left posterior cerebral artery (arrow, figure, top right). Follow up gadolinium enhanced T1 weighted cranial MRI showed persistent left temporal horn entrapment and the development of a thick enhancing rind (figure, bottom left), consistent with septic infarction. The patient underwent craniotomy and abscess excision, and microscopy and Papanicolaou staining of the specimen showed the presence of large irregular wide hyphae characteristic of mucormycosis (figure, bottom right). The patient was maintained on high dose liposomal amphotericin, and made a good postoperative recovery.