[Garcin syndrome in a patient with rhinocerebral mucormycosis].
Garcin syndrome is characterized by an unilateral cranial nerves involvement without sensory or motor long-tract disturbances. It is usually caused by tumor infiltrating in the skull base with osteolytic changes on radiological study. We report a case of 64-year-old man with history of alcohol overintake, who admitted local hospital, because of right periorbital edema and facial swelling. He noted right ptosis 2 weeks prior to admission. Neurological examination revealed right multiple cranial nerves involvement including II, III, IV, V, and VI cranial nerves. MR imaging of the brain showed marked paranasal sinusitis and abnormal infiltration of right orbital fat. Orbital apex syndrome related to paranasal sinusitis was diagnosed, and antibiotics was administered. But a few days after admission, he developed a right VII, IX, X cranial nerve palsy. He was transferred to our hospital because of acute development of left hemiparesis and deteriorated consciousness. MR imaging of the brain showed right internal carotid artery (ICA) occlusion, and infarction in right middle cerebral artery (MCA)'s territory. The diagnostic biopsy of the paranasal sinus showed mucorales hyphae, indicating that the pathological diagnosis was mucormycosis. Despite of antibiotic therapy included of amphotericin-B administration and strict control of diabetic mellitus, his sinusitis was gradually spread. His condition progressively deteriorated, and finally died of sepsis. Post-mortem examination revealed a widespread mucor infiltration in the dura mater without skull bone invasion. This case presented with unilateral multiple cranial nerve involvements (Garcin syndrome) followed by left hemiparesis associated with rhinocerebral mucormycosis. It is suggested that mucormycosis should be considered in case of Garcin syndrome without osteolysis in the skull base.
Mutsukura
Kazuo
K
5th Department of Internal Medicine, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Johnan-ku, Fukuoka 814-0180, Japan.
Tsuboi
Yoshio
Y
Imamura
Akiko
A
Fujiki
Fujio
F
Yamada
Tatsuo
T
D001157:Arterial Occlusive Diseases / Q000209:etiology; D001927:Brain Diseases / Q000150:complications*; D002340:Carotid Artery Diseases / Q000209:etiology; D002343:Carotid Artery, Internal; D002544:Cerebral Infarction / Q000209:etiology; D003389:Cranial Nerve Diseases / Q000209:etiology*; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D008875:Middle Aged; D009091:Mucormycosis / Q000150:complications*; D009668:Nose Diseases / Q000150:complications*; D009916:Orbital Diseases / Q000150:complications*; D010254:Paranasal Sinus Diseases / Q000150:complications*; D013577:Syndrome