PMC6443639_01
Initial CT head demonstrating periorbital edema and inflammation in the ethmoid and maxillary sinuses. There is no evidence of acute intracranial abnormality.
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F1
Immediate CT of the head revealed no obvious acute abnormalities (Figure 1); however, CTA head demonstrated occlusion of the cavernous segment of the RICA.
(Top): AP (left) and lateral (right) digital subtraction angiogram illustrating right ICA terminus occlusion on common carotid injection. (Bottom): AP (left), lateral (right) demonstrating TICI III recanalization after thrombectomy.
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F2
Utilizing standard thrombectomy techniques, a TICI III (Thrombolysis in Cerebral Infarction) revascularization was achieved (Figure 2) using a retrievable stent system.
Diffusion weighted imaging (DWI) sequences demonstrating diffusion restriction in the basal ganglia that is characteristically seen in rhinocerebral mucormycosis.
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F3
Post-procedural MRI demonstrated diffusion restriction over the right basal ganglia, middle and inferior frontal lobes, and anterior temporal lobe (Figure 3).
(Left) Gomori methenamine silver (GMS) stain highlighting fungal wall and the pathognomonic non-septate branching hyphae. (Right) High-power H&E stain demonstrating hyphae and inflammatory cells with limited blood product. Photo Credit: Sin Nguyen, MD.
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F4
Final pathology and culture were positive for fungal hyphae consistent with RCM (Figure 4).