Abstract Details

Title Neuroradiological profile of Rhinoorbitocerebral mucormycosis in COVID-19 pandemic.

Topic Infectious Disease

Presentation(s) S18 - COVID-19: From Bedside and Beyond (2:12 PM-2:24 PM)

Poster/Presentation
Number 007

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.

Authors/Disclosures
P.Haritha Kumari, MD, DM PRESENTER	Dr. Kumari has nothing to disclose.
Lakshmi N. Ranganathan, MD, FAAN	Dr. Ranganathan has nothing to disclose.
Thamilpavai Natarajan, MD	Dr. Natarajan has nothing to disclose.
Shrivarthan R	Mr. R has nothing to disclose.

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