An Unusual Cause of Intracranial Hemorrhage: Cerebral Mucormycosis

Abstract

Invasive mucormycosis is a rare but potentially fatal infection which affects predominantly immunocompromised patients. Among the different entities, rhino-orbito-cerebral mucormycosis implies a high mortality risk, as well as significant sequelae. We present a case of a young diabetic man who presented to our hospital with alteratered mental status after several episodes of ketoacidosis. He required orotracheal intubation and admission to the Intensive Care Unit. A computed tomography was performed, which showed bilateral intracranial hemorrhage with signs of intracranial hypertension. He underwent urgent surgery for hematoma evacuation and primary decompressive craniectomy. Due to the severity of the brain damage, the team decided to monitor the intracranial pressure invasively. After the finding of hyphae in surgical samples, broad-spectrum antifungal therapy was initiated. Despite all the therapeutic measures, including third tier measures with barbiturate coma, the patient developed refractory intracranial hypertension. Given the fateful prognosis and the absence of other treatment options, the team decided, in accordance with his relatives, withdrawal of life-sustaining measures.