Intracranial phycomycosis: A clinicopathological and radiological study

In 3 patients with diabetes mellitus and ketoacidosis and one with uremia from chronic renal disease, phycomycotic infection extended into the intracranial cavity from the paranasal sinuses, leading to death in all 4 cases. Striking angiographic changes occurred in 3 cases, consisting of irregular narrowings of intracranial arteries, at times with stenosis or occlusion, and in 1 case, findings indicative of a mycotic aneurysm. The clinical and radiographic findings could be correlated with the pathological changes in the carotid arteries and their branches, which resulted from invasion and destruction of the arterial wall by the fungus. This in turn led to thrombus formation and infarction of brain tissue, either directly or as a result of embolization; the mycotic aneurysm was a consequence of the distinctive alteration of the wall of the internal carotid artery. In all 4 cases biopsy specimens showed the presence of a fungus of the class Phycomycetes. In 3, the organisms were identified by culture as belonging to the genus Rhizopus of the family Mucoraceae. Treatment with amphotericin B may have inhibited growth of the organisms in 1 case, but was ineffective in controlling the infection in any of the cases.