Rhinocerebral Mucormycosis with Top of Basilar Artery Syndrome

Abstract

Our objective is to highlight the varied forms of vascular dissemination of rhinocerebral mucormycosis resulting in ischemic arterial syndromes, especially rare posterior ischemic circulatory strokes, through dissemination of mucormycosis from sphenoid bone to clivus by bony erosion and to the basilar artery, thus causing the top of basilar artery syndrome. We have reported a case of rhinocerebral mucormycosis in an uncontrolled diabetic patient presented to the neurointensive care unit, department of neurology. A 56-year-old male diabetic patient with poorly controlled glycemic levels presented with pansinusitis resulting in rhinocerebral mucormycosis with basilar artery erosion through clivus bone erosion from sphenoid sinus. Mucormycosis is caused by fungi. Mucormycosis is commonly reported in immunocompromised patients such as poorly controlled diabetes mellitus, blood dyscrasias, malnutrition, neutropenia, iron overload, organ transplant, and immunosuppressive therapy. Mucormycosis rises with an increase in incidence of diabetes mellitus and HIV infection leading to immunocompromised status of the patient. In our case, there is invasion to the sphenoid bone and to clivus by bony erosion and to the basilar artery, thus causing the top of basilar artery syndrome, which is very unusual. Mucormycosis has a very fatal rapid progression with varied forms of cerebral dissemination with high mortality; hence early recognition and aggressive treatment are needed to increase the survival rate.