J Stroke Cerebrovasc Dis . Cerebrovascular Involvement in Mucormycosis in COVID-19 Pandemic

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J Stroke Cerebrovasc Dis


. 2021 Nov 22;31(2):106231.
doi: 10.1016/j.jstrokecerebrovasdis.2021.106231. Online ahead of print.
Cerebrovascular Involvement in Mucormycosis in COVID-19 Pandemic


Rahul Kulkarni ¹ , Shripad S Pujari ² , Dulari Gupta ³ , Pawan Ojha ⁴ , Megha Dhamne ⁵ , Vyankatesh Bolegave ⁶ , Pramod Dhonde ⁷ , Anand Soni ⁸ , Sikandar Adwani ⁹ , Anand Diwan ¹⁰ , Dhananjay Duberkar ¹¹ , Dhruv Batra ¹² , Rushikesh Deshpande ³ , Kaustubh Aurangabadkar ¹³ , Nilesh Palasdeokar ¹⁴



Affiliations

• PMID: 34890962
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106231

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.

Keywords: COVID-19 associated mucormycosis, Mucormycosis associated stroke, Cerebrovascular involvement, COVID-19; COVID-19, Mucormycosis, Stroke.