Case Series
Volume 12 Issue 11 - 2020
Diagnostic Dilemma of Intracranial Fungal Granuloma Risk Versus Benefit Assessment Before Neurosurgical Management
Saeed Mazher*, Abdul Ali Khan, Zaheen Shibli, Abdul Lateef Soneja, Shafatullah and Ahmed Ali
Neurosurgery Neurology and Plastic Surgery Department, Baqai University Hospital, Pakistan
*Corresponding Author: Saeed Mazher, Neurosurgery Neurology and Plastic Surgery Department, Baqai University Hospital, Pakistan.
Received: September 25, 2020; Published: October 30, 2020




Abstract

Objective: MRI and outcome based learning experience in the management of intracranial fungal granulomas and atypical brain infections (IFG) considering risk versus benefit before neurosurgical interventions.

Methods: We performed a retrospective analysis of all patients with diagnosed IFG or anticipated diagnosis based predominantly on imaging from 2011 to 2019 collected data included clinical history, lab results treatment and review of all imaging studies performed. Among these cases, one case required additional consideration of histopathological confirmation due to refractory response to anti-fungal medication and subsequent deterioration of neurology of patient hence neurosurgical intervention was done in that individual case. The variables were symptoms and signs at presentation, predisposing factors, location of granuloma, involvement of paranasal sinuses, diagnostic studies including blood and urine cultures, septic profile, surgical procedure performed along with histopathology treatment and prognosis. Computed tomography and magnetic resonance imaging scans were performed.

Results: Predominant symptoms included headache (83%) vomiting proptosis (48%) and visual disturbances. Other symptoms were fever, nasal congestion and seizures (18%). Common signs included papilledema with cranial neuropathy I, III, IV, VI and V in patients respectively. Predisposing factors were diabetes and immunocompromise status related to renal dialysis, transplant and tumor. Location was primarily frontal 1 parasellar sellar 1 involvement. One patient underwent frontal craniotomy for resection of fungal granuloma abscess histopathology revealed aspergilloma. All patients treated with itraconazole. Few were offered fluconazole, flucytosine and amphotericin B for a brief period. Mortality 1 secondary to meningoencephalitis.

Conclusion: Early diagnosis, risk versus benefit assessment oriented surgical decompression and prophylactic anti-fungal course according to variability of case with prompt initiation of antifungal therapy showed better outcome. Preoperative oral administration of itraconazole therapy improve clinical outcome in patients with aspergillosis. Larger prospective clinical studies are required to make firm clinical therapeutic recommendations.

Medical therapy with anti-fungal agents is required for prolonged periods following surgery in patients with IFM. In spite of several advances in imaging and surgical techniques and the advent of some newer antifungal agents, the prognosis for patients with IFM continues to remain grim and mortality rates range between 40 and 90% [1].

Keywords: Intracranial Fungal Granuloma (IFG); Antifungal Therapy (AFT); Rhino-orbital Cerebral Mucormycosis (ROCM)

References

    1. Vedanta Rajshekhar. “Surgical management of intracranial fungal masses: review article”. 55.3 (2007): 267273.
    2. Anais sic EJ., et al. “Editors clinical mycology”. New York Churchill living stone (2003).
    3. Sharma RR., et al. “Surgical management of fungal infections of the central nervous system”. In: Schmedek HH and Roberts DW. “Schmidek and sweets operative neurosurgical techniques, indications, methods and results”. 5th edition (2006): 1633-1671.
    4. Yohai RA., et al. “Survival factors in rhino-orbital-cerebral mucormycosis: major review”. Survey of Ophthalmology 39 (1994): 3-22.
    5. Ferry AP and Abedi S. “Diagnosis and management of rhino-orbitocerebral mucormycosis (phycomycosis): a report of 16 personally observed cases”. Ophthalmology 90 (1983): 1096-1104.
    6. Gregory JL., et al. “Mucormycosis of the central nervous system: a report of three cases”. Bulletin of the Johns Hopkins Hospital 73 (1943): 302-313.
    7. Parfrey NA. “Improved diagnosis and prognosis of mucormycosis: a clinicopathologic study of 33 cases”. Medicine65 (1986): 113-123.
    8. Utz JP., et al. “Therapy of cryptococcosis with a combination of flucytosine and amphotericin B”. The Journal of Infectious Diseases 132 (1975): 368-373.
    9. Bennett JE., et al. “A comparison of ampho-tericin B alone and combined with flucytosine in the treatment of cryptococcal meningitis”. The New England Journal of Medicine 301 (1979): 126-131.
    10. Eilard T., et al. “Treatment of disseminated candidiasis with 5-fluorocytosine”. The Journal of Infectious Diseases 130 (1974): 159-159.
    11. “Physicians Desk Reference”. Oradell, NJ: Medical economics (1992): 1886.
    12. Dismukes WE., et al. “Treatment of cryptococcal meningitis with combination amphotericin Band flu – cytosine for four as compared with six weeks”. The New England Journal of Medicine 17 (1987): 334-341.
    13. Stamm AM., et al. “Toxicity of amphotericin B plus flucytosine in 194 patients with cryptococcal meningitis”. The American Journal of Medicine 83 (1987): 236-242.
    14. Marcinkowski M., et al. “Fungal brain abscess in neonates: Sonographic appearances and corresponding histopathologic findings”. Journal of Clinical Ultrasound 29 (2001): 417-421.
    15. Dubey A., et al. “Intracranial fungal granuloma: Analysis of 40 patients and review of the literature”. Surgical Neurology International 63 (2005): 254-260.
    16. Nadkarni T and Goel A. “Aspergilloma of the brain: An overview”. Journal of Postgraduate Medicine 51 (2005): 37-41.
    17. Siddiqui AA., et al. “Craniocerebral aspergillosis of sinonasal origin in immunocompetent patients: Clinical spectrum and outcome in 25 cases”. Neurosurgery 55 (2004): 602-613.
    18. Hurst RW., et al. “Mycotic aneurysm and cerebral infarction resulting from fungal sinusitis: Imaging and pathological correlation”. American Journal of Neuroradiology 22 (2001): 858-863.
Citation: Saeed Mazher., et al. “Diagnostic Dilemma of Intracranial Fungal Granuloma Risk Versus Benefit Assessment Before Neurosurgical Management”. EC Neurology 12.11 (2020): 52-60.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 08, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk