Spectrum of neurological involvement in mucormycosis following COVID 19: A single tertiary centre study

Background: This study aims to describe the clinical and imaging spectrum of neurological involvement in rhino-orbital cerebral mucormycosis (ROCM) following COVID. In this observational study, all patients with confirmed COVID associated mucormycosis were recruited. Consecutive patients with neurological signs and symptoms or patients with evidence of neurological involvement based on imaging were evaluated. MRI of brain and paranasal sinuses were done in 3T MRI scanner and evaluated by a radiologist. Results: A total of 182 patients were recruited into the study out of which 72 (39.56%) patients had neurological involvement. The mean age of the patients was 50.31 +/- 11.06 (Range: 33-83) years. A male preponderance was noted with 56 (74.67%) patients being male. The commonest symptom reported was unilateral vision impairment and periorbital swelling. Patients were noted to have both fulminant and indolent course of illness. Clinical evidence of neurological and orbital involvement was observed in 33 and 55 patients, respectively. Meningeal involvement (50%) was the commonest imaging finding noted in our study. Other common findings noted were skull based osteomyelitis (44.44%), cavernous sinus thrombosis (29.17%), intracranial abscess (27.78%), cerebritis (22.22%), infarcts (33.33%), neuritis and intracranial haemorrhage (2.78%).Conclusion: This study reports one of the largest single centre cohorts with neurological findings in COVID associated mucormycosis. COVID associated mucormycosis can present with plethora of neurological manifestations in imaging, such as infarct, intracranial and extracranial abscess, neuritis and nerve abscess, sinus thrombosis that may or may not be accompanied by focal neurological deficit corresponding to the anatomical involvement.