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Neurological picture
Cerebral mucormycosis
Free
  1. DANIEL BIRCHALL
  1. Interventional Neuroradiology Unit
  2. Department of Neurology
  3. Interventional Neuroradiology Unit Royal Perth Hospital, Western Australia
  1. Dr D Birchall, Interventional Neuroradiology Unit, Royal Perth Hospital, GPO Box X2213, Perth 6001, Western Australia. Telephone 0061 8 9 224 2126; fax 0061 8 9 224 3765; emaildanibirc{at}rph.health.wa.gov.au
  1. WAI K LEONG
  1. Interventional Neuroradiology Unit
  2. Department of Neurology
  3. Interventional Neuroradiology Unit Royal Perth Hospital, Western Australia
  1. Dr D Birchall, Interventional Neuroradiology Unit, Royal Perth Hospital, GPO Box X2213, Perth 6001, Western Australia. Telephone 0061 8 9 224 2126; fax 0061 8 9 224 3765; emaildanibirc{at}rph.health.wa.gov.au
  1. WILLIAM MCAULIFFE
  1. Interventional Neuroradiology Unit
  2. Department of Neurology
  3. Interventional Neuroradiology Unit Royal Perth Hospital, Western Australia
  1. Dr D Birchall, Interventional Neuroradiology Unit, Royal Perth Hospital, GPO Box X2213, Perth 6001, Western Australia. Telephone 0061 8 9 224 2126; fax 0061 8 9 224 3765; emaildanibirc{at}rph.health.wa.gov.au

http://dx.doi.org/10.1136/jnnp.66.3.404

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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.