Cerebral mucormycosis: neuroimaging findings and histopathological correlation

Introduction Mucormycosis are infections caused by molds of the order Mucorales. These opportunistic infections are rare, difficult to diagnose, and have a poor prognosis. We aimed to describe common radiographic patterns that may help to diagnose cerebral mucormycosis and search for histopathologic...

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Published in:Journal of neurology 2022-03, Vol.269 (3), p.1386-1395
Main Authors: Lersy, François, Royer-Leblond, Julie, Lhermitte, Benoit, Chammas, Agathe, Schneider, Francis, Hansmann, Yves, Lefebvre, Nicolas, Denis, Julie, Sabou, Marcela, Lafitte, François, Cotton, François, Boncoeur-Martel, Marie-Paule, Tourdias, Thomas, Pruvo, Jean-Pierre, Cottier, Jean-Philippe, Herbrecht, Raoul, Kremer, Stéphane
Format: Article
Language:English
Subjects:
Abscesses
Aspergillosis
Basal ganglia
Cardiovascular system
Computed tomography
Diabetes mellitus
Fungal infections
Hemorrhage
Humans
Immune status
Immunocompromised Host
Infections
Ischemia
Lesions
Life Sciences
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Medicine
Medicine & Public Health
Mucorales
Mucormycosis
Mucormycosis - diagnostic imaging
Mucormycosis - microbiology
Neuroimaging
Neurology
Neuroradiology
Neurosciences
Original Communication
Santé publique et épidémiologie
Stenosis
Thrombosis
Trigeminal nerve
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Summary:Introduction Mucormycosis are infections caused by molds of the order Mucorales. These opportunistic infections are rare, difficult to diagnose, and have a poor prognosis. We aimed to describe common radiographic patterns that may help to diagnose cerebral mucormycosis and search for histopathological correlations with imaging data. Methods We studied the radiological findings (CT and MRI) of 18 patients with cerebral mucormycosis and four patients’ histopathological findings. Results All patients were immunocompromised and/or diabetic. The type of lesions depended on the infection’s dissemination pathway. Hematogenous dissemination lesions were most frequently abscesses (59 lesions), cortical, cortical–subcortical, or in the basal ganglia, with a halo aspect on DWI for lesions larger than 1.6 cm. Only seven lesions were enhanced after contrast injection, with different presentations depending on patients’ immune status. Ischemia and hemorrhagic areas were also seen. Vascular lesions were represented by stenosis and thrombosis. Direct posterior extension lesions were bi-fronto basal hypodensities on CT and restricted diffusion without enhancement on MRI. A particular extension, perineural spread, was seen along the trigeminal nerve. Histopathological analysis found endovascular lesions with destruction of vessel walls by Mucorales, microbleeds around vessels, as well as acute and chronic inflammation. Conclusions MRI is the critical exam for cerebral mucormycosis. Weak ring enhancement and reduced halo diffusion suggest the diagnosis of fungal infections. Involvement of the frontal lobes should raise suspicion of mucormycosis (along with aspergillosis). The perineural spread can be considered a more specific extension pathway of mucormycosis.
ISSN:0340-5354
1432-1459
DOI:10.1007/s00415-021-10701-8