Multiple subcortical strokes caused by mucormycosis in a patient with lymphoma.

A 56-year-old man was diagnosed with follicular nonHodgkin’s lymphoma. Four months prior to admission, he presented a right headache attributed to rhinosinusitis. Biopsy showed mucormycosis. There was no affectation intracranial in the brain magnetic resonance imaging (MRI), but the patient became blind due to involvement of both central retinal arteries. He underwent debridement of the paranasal sinuses and treatment with liposomal amphotericin B for two months and posaconazole continuously. He was admitted by recurrent episodes of nonfluent aphasia, right sensory disturbance, and motor weakness. In the last episode, the symptoms persisted and the patient had transcortical motor aphasia, right hemiparesis with dominance of the lower limb (manual muscle testing: upper limb 2/5, lower limb 1/5) and right unilateral sensory impairment, which was restricted at his perioral area and homolateral distal hand and foot. Hemogram showed lymphopenia (0,3x109/L) and thrombocytopenia (23x109/L). Blood clotting was normal. Plasma and urine ketone bodies were absent and other laboratory studies were normal. Echocardiogram, cardiac monitoring and Duplex of the supra-aortic trunk were normal. Transcranial duplex showed 70% stenosis at the M1 segment of left middle cerebral artery (MCA) with no other significant changes. MRI brain on T1 sequences with contrast (Fig A) showed an uptake at both cavernous sinus and internal carotid wall, which