Cerebellar infarction and aneurysmal subarachnoid hemorrhage: An unusual presentation and rare complications of rhinocerebral mucormycosis.

The most common clinical presentation of mucormycosis is rhino-orbital-cerebral infection, which is supposed to begin with inhalation of spores into the paranasal sinuses of a vulnerable host. Hyperglycemia, with an associated metabolic acidosis, is the most common underlying state.1 The hallmarks of spread outside the sinuses are tissue necrosis of the palate.1,2 We present a 57-year-old man admitted to the emergency department of Ghaem Hospital affiliated to Mashhad University of Medical Sciences, Iran, with fever, decreased the level of consciousness, and left facial swelling from 1 week before admission. He was known the case of diabetes mellitus from 2 years before, and he was under treatment with oral hypoglycemic agents. Initiation of his symptoms was with a common cold and headache from 20 days before. He was smoker and opiate addict. His drug history was glibenclamide, amlodipine, acyclovir ophthalmic drop and oral diazepam tablets. On physical examination, the patient was febrile (temperature: 39 °C). Ear nose and throat examination showed facial asymmetry due to complete ptosis, significant edema of the right eyelid, palatal necrosis and left alveolar ridge necrosis. On the left side of the nose middle and inferior conchae necrosis was observed. The right side of the nose was normal. On mental status examination, he was drowsy but he was conscious and obeyed the commands. Examination of cranial nerves showed that he had multiple cranial nerve palsy. Fundoscopy was normal. The left eye had ptosis and pupil was mydriatic and non-reactive. Left frozen eye (3, 4, 6 cranial neuropathies) hypoesthesia of the left side of the face (V1, V2 of left fifth cranial neuropathy) left peripheral seventh nerve palsy (previous bell’s palsy). Other cranial nerves were normal. The motor examination was normal. Examination of sensory and gait of the patient was unremarkable because of his drowsiness. Ophthalmology and otolaryngology consult performed urgently. Iranian Journal of Neurology