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Images in Neurology
March 2006

Bilateral Basal Ganglionic Hemorrhage

Arch Neurol. 2006;63(3):464. doi:10.1001/archneur.63.3.464

A 49-year-old man without significant past illness was admitted with a 5-day history of seizures, low-grade fever, drowsiness, and bilateral hemiparesis. Brain computed tomographic scan without contrast showed bilateral basal ganglionic hemorrhage (Figure 1). Contrast-enhanced computed tomographic and magnetic resonance imaging scans revealed no sinus or orbital disease. Intravenous therapy with acyclovir sodium, ceftriaxone, vancomycin hydrochloride, and phenytoin sodium was commenced. His weakness and level of consciousness worsened over the next 3 days and treatment with intravenous amphotericin B and corticosteroids was added. The therapy failed to control his clinical deterioration and he died 9 days after the hospitalization. Whole body autopsy revealed basal ganglionic hemorrhage extending into the ventricles and softening of the surrounding white matter. Microscopic examination revealed thin-walled nonseptate fungal hyphae, branching at right angles, and the contiguous round fungal spores, a morphology characteristic of mucormycosis (Figure 2). No extracerebral fungal lesion was discovered.