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Fungal Space Occupying Lesions in Brain after COVID-19: A Double Attack

Shripad S. Pujari , Shripad S Pujari1 , Rahul V Kulkarni2 , Dulari Gupta3 , Kaustubh Dindorkar4 , Chandrashekhar Raman5 , Nilesh Palasdeokar6 , Rushikesh Deshpande7 , Bharat Purandare8 , Parikshit Prayag9 , Ameet Dravid10 , Sampada Patwardhan11 , Pradnya Jawalekar12

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International Journal of Neurology and Neurosurgery 14(3):p 81-86, July-September 2022. | DOI: 10.21088/ijnns.0975.0223.14322.7

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Shripad S Pujari, Rahul V Kulkarni, Dulari Gupta, et al./Fungal Space Occupying Lesions (SOLs) in Brain after COVID-19: A Double Attack/Int J Neurol Neurosurg.2022;14(3): 81-86.

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Abstract

Context: COVID-19 predisposes to rhino-orbito-cerebral mycosis (ROCM) which can further form fungal space occupying lesions (SOLs) in the brain. Aim: To study the clinico-radiological profile, type of fungus, response to treatment, outcomes and prognostic factors in patients with COVID-19 associated mucormycosis (CAM) who suffered fungal space occupying lesions (SOLs) in the brain. Results: Twelve subjects with CAM and intracranial SOLs were studied. Brain scans were performed in all patients at rhino-orbital stage, even before appearance of brain symptoms. The localized pus collections manifested as either parenchymal abscesses (N=10) or subdural empyema (N=2). In addition to involving the brain adjacent to the rhino-orbital disease, abscesses were also seen to form in areas distant to the primary site of infection. Abscesses developed in two regions, in the midline at the base of the skull, around the cavernous internal carotid arteries or the basilar arteries and in the lateral frontal, parietal and occipital lobes. Mucormycosis was identified in all patients and dual infection with aspergillus was encountered in 25%. Treatment involved combination of anti-fungal agents and early excision surgery and the mortality was 33%. Conclusion: Fungal abscesses form in the brain at sites contiguous to the rhino-orbital disease and also at distance sites via hematogenous route. These pus collections can be diagnosed early by screening the brain while undertaking the scan of orbits and paranasal sinuses. Mortality is high if pus spreads around the cavernous portion of the internal carotid or the basilar artery. Dual infection with mucorales and aspergillus can be seen. Early aggressive treatment can improve outcome and reduce mortality. Keywords: rhino-orbito-cerebral mycosis (ROCM), pus collection, parenchymal abscess, subdural empyema, contiguous spread, hematogenous spread.

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Shripad S Pujari, Rahul V Kulkarni, Dulari Gupta, et al./Fungal Space Occupying Lesions (SOLs) in Brain after COVID-19: A Double Attack/Int J Neurol Neurosurg.2022;14(3): 81-86.

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DOI: 10.21088/ijnns.0975.0223.14322.7

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