Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy

Peterus Thajeb; Teguh Thajeb; Daofu Dai

doi:10.1080/00365540410020794

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Journal article

Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy

Peterus Thajeb, Teguh Thajeb and Daofu Dai

Scandinavian journal of infectious diseases, Vol.36(9), pp.643-648

2004

DOI: 10.1080/00365540410020794

PMID: 15370650

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Abstract

Within a 10-y period, fatal strokes occurred during parenteral administration of amphotericin B and surgical debridement of paranasal sinuses in 6 pathologically verified cases of rhino-orbito-cerebral mucormycosis (ROCM). All patients had unnoticed type-2 diabetes mellitus without ketoacidosis. They presented with unilateral orbital cellulitis and cavernous sinus syndrome. Fatal malignant cerebral infarctions occurred in the carotid system in 5 patients, and in the basilar artery or its major branches in 2 patients. Accelerated thrombotic occlusion of the cavernous portion of the carotid artery or the basilar artery was likely to be due to mucormycosis associated-vasculopathy and diabetic vasculopathy. One patient died of massive subarachnoid hemorrhage following rupture of the mycotic aneurysm. Despite parenteral administration of amphotericin B, fatal outcome of ROCM in patients with unnoticed diabetes mellitus occurs due to mucormycosis-associated malignant strokes. To improve outcome, a combination of early radical debridement, ocular exenteration, parenteral and local administration of amphotericin B, and decompression craniotomy should be considered.

Immunohistochemistry

Mucormycosis - mortality

Nose Diseases - microbiology

Humans

Middle Aged

Male

Vasculitis, Central Nervous System - mortality

Sampling Studies

Cause of Death

Antifungal Agents - therapeutic use

Orbital Diseases - mortality

Central Nervous System Fungal Infections - microbiology

Female

Nose Diseases - mortality

Orbital Diseases - drug therapy

Stroke - mortality

Mucormycosis - drug therapy

Severity of Illness Index

Stroke - microbiology

Vasculitis, Central Nervous System - drug therapy

Risk Assessment

Mucormycosis - diagnosis

Stroke - drug therapy

Vasculitis, Central Nervous System - microbiology

Orbital Diseases - microbiology

Magnetic Resonance Imaging

Cerebral Angiography

Central Nervous System Fungal Infections - mortality

Taiwan

Aged

Central Nervous System Fungal Infections - drug therapy

Biopsy, Needle

Nose Diseases - drug therapy

Details

Title: Subtitle: Fatal strokes in patients with rhino-orbito-cerebral mucormycosis and associated vasculopathy
Creators: Peterus Thajeb - Department of Neurology, Mackay Memorial Hospital, Taipei, Taiwan, ROC. thajebp@hotmail.com
Teguh Thajeb
Daofu Dai
Resource Type: Journal article
Publication Details: Scandinavian journal of infectious diseases, Vol.36(9), pp.643-648
Publisher: England
DOI: 10.1080/00365540410020794
PMID: 15370650
ISSN: 0036-5548
eISSN: 1651-1980
Language: English
Date published: 2004
Academic Unit: Pathology; Iowa Neuroscience Institute; Radiation Oncology
Record Identifier: 9984047668002771

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