1. Cerebrovascular Involvement in Mucormycosis in COVID-19 Pandemic.
- Author
-
Kulkarni R, Pujari SS, Gupta D, Ojha P, Dhamne M, Bolegave V, Dhonde P, Soni A, Adwani S, Diwan A, Duberkar D, Batra D, Deshpande R, Aurangabadkar K, and Palasdeokar N
- Subjects
- Adult, Aged, COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 Testing, Cerebrovascular Disorders epidemiology, Female, Humans, Incidence, India epidemiology, Male, Middle Aged, Mucormycosis diagnosis, Mucormycosis epidemiology, Pandemics, Retrospective Studies, Reverse Transcriptase Polymerase Chain Reaction, SARS-CoV-2 genetics, Stroke epidemiology, COVID-19 complications, Cerebrovascular Disorders complications, Mucormycosis complications, SARS-CoV-2 isolation & purification
- Abstract
Background: Many countries have seen an unprecedented rise of cases of coronavirus disease 2019 (COVID-19) associated mucormycosis (CAM). Cerebrovascular involvement in CAM has not been studied so far. We describe clinico-radiological manifestations of cerebrovascular complications observed in CAM., Methods: In this multicentric retrospective observational study from India, patients with CAM who developed cerebrovascular involvement were studied. Their demographics, risk factors, clinical manifestations, imaging, laboratory profile and outcomes were noted., Results: Out of 49 subjects with cerebrovascular involvement, 71.4% were males while average age was 52.9 years. Ischemic stroke was commonest (91.8%) followed by intracranial haemorrhage (6.1%) and subarachnoid haemorrhage (2%). The incidence of cerebrovascular complications in CAM was found to be 11.8% in one center. Cerebrovascular symptoms appeared a median of 8.3 days from the onset of mucormycosis. Commonest presentation of mucormycosis was rhino-orbito-cerebral syndrome in 98%. Diabetes mellitus was present in 81.7%. Forty percent developed stroke despite being on antiplatelet agent and/or heparin. Amongst subjects with ischemic strokes, location of stroke was unilateral anterior circulation (62.2%); bilateral anterior circulation (17.8%); posterior circulation (11.1%) and combined anterior and posterior circulation (8.9%). Vascular imaging revealed intracranial occlusion in 62.1%; extracranial occlusion in 3.4% and normal vessels in 34.5%. Mortality was 51% during hospital stay., Conclusions: Cerebrovascular involvement was seen in 11.8% patients of CAM. Angio-invasive nature of the fungus, prothrombotic state created by COVID-19, and diabetes were important causative factors. Subjects with CAM should be screened for involvement of the brain as well as its vessel. Antiplatelet agents/heparin did not seem to provide complete protection from this type of stroke., Competing Interests: Declaration of Competing Interest None., (Copyright © 2021 Elsevier Inc. All rights reserved.)
- Published
- 2022
- Full Text
- View/download PDF