Intracranial extension in COVID-19 associated mucormycosis cases
Poorvi Tangri1, Awadh Pandit1, Shubham Misra3, Achal Srivastava4, Vishnu VY1, Rajesh Kumar Singh2, Divya MR5
1Neurology, All India Institute of Medical Sciences, New Delhi, 2All India Institute of Medical Sciences, New Delhi, 3Neurology, Yale University School of Medicine, 4Neurology, AIIMS, 5AIIMS New Delhi
Objective:
To describe  COVID-19 associated rhino-orbital-cerebral mucormycosis (ROCM) patients.
Background:
During the rampantly spreading pandemic of COVID-19, India observed a surge in mucormycosis cases. The most common form of secondary infection noted in COVID-19 infected immunocompromised patients was mucormycosis. The infection mainly spread through the nasal passage and in few uncontrolled cases, it crossed the dura mater and presented itself as rhino-orbital-cerebral mucormycosis.
Design/Methods:

The study was conducted after Institute Ethics Committee approval. ROCM cases were studied in detail, their demographic, radiological data, treatment details and 90 days’ follow-up are described. 

Results:

The most effective tool for diagnosis and confirmation of mucormycosis within time is magnetic resonance imaging (MRI) and histopathological techniques. The chief complaints of patients inflicted with COVID-19 associated mucormycosis were headache, fever, ophthamloplegia, ptosis, ulceration, diminution of vision, and general weakness. Infarcts were observed in 55.55% (15/27) of the cases, in right parietal lobe, right periventricular region, right cerebral infarcts, acute infarct in left frontal parietal lobe, bilateral frontal and left occipital lobe. Most common form of infarct was lacunar infarct. Haemorrhage was detected in only three patients 11.53% (3/26). Abscess formation was seen in 26.92% (7/26) patients in right temporal region, cavernous sinus and left temporal lobe. Three of the patients displayed meninges involvement and thrombosis was seen in 44% (11/25) of the total patients in internal carotid artery (ICA) in six patients, in cavernous sinus in two patients and in superior ophthalmic vein in one patient.

Conclusions:

Our case-series showed intracranial extension of mucormycosis in COVID-19 patients predominantly inform of thrombosis followed by intracranial abscess and haemorrhage. Appropriate care, anti-fungal medication and surgical procedures should be performed in conjunction to manage the spread of disease. 

10.1212/WNL.0000000000202919