Presentation
Post-covid status, known case of diabetes mellitus, treated with steroids. Present complains of headache and inability to open eyes.
Patient Data
Mucosal thickening is seen in all paranasal sinuses.
Soft tissue is seen extending to bilateral orbits with edema/fat stranding involving bilateral orbital fat. Edema is seen involving bilateral optic nerves with diffusion restriction. Periorbital soft tissue edema is also seen. These findings are consistent with bilateral orbital, periorbital cellulitis and optic neuritis.
Abscess is seen in right basifrontal lobe showing evidence of diffusion restriction. Small abscess is also seen in left basifrontal lobe. Surrounding edema is seen in bilateral basifrontal lobes.
Punctate areas of loss of normal marrow signal is seen involving clivus with edema on stir/FAT SAT sequences, possibly representing early involvement of clivus in the infective process.
Edema is also seen in bilateral intra temporal fossa.
Lacunar infarcts and ischemic lesions in bilateral periventricular, deep and subcortical white matter.
Age related cerebral atrophy is seen.
Bilateral mastoiditis is seen.
Erosions are seen in bilateral cribriform plates, lamina papyracea, roof of right frontal sinus and sphenoid septum. Erosions are also seen in nasal turbinates, more on right side. Perforation of bony nasal septum is seen. Suspicious erosions are seen in visualized clivus.
Incidental rhinolith seen on right side.
Case Discussion
Overall findings of MRI and CT are suggestive of rhino-oculo-cerebral mucormycosis.
Contrast enhanced study could not be performed as the patient had deranged kidney functions.