A Case of Cerebellar Infarction with Renal Artery Stenosis / 대한뇌졸중학회지

Renal artery stenosis (RAS) is defined as a narrowing of main renal artery or its major branches over 50%, and can be the cause of pulmonary edema, renal failure, malignant hypertension and cerebrovascular diseases. The renin-angiotensin-aldosterone system works as a key role. In this paper, we report a case of a 53 year-old patient with left middle cerebellar peduncle infarction, who showed malignant hypertension and RAS. The RAS was diagnosed by renal artery computed tomography angiography and treated with renal artery angioplasty, stenting and antihypertensive medication. In a young patient with ischemic stroke who has refractory hypertension against antihypertensive medications, RAS should be suspected and evaluated.

Rhino-orbito-cerebral Mucormycosis Complicated with Intracranial Hemorrhage

Rhino-orbito-cerebral mucormycosis is an uncommon fulminant fungal infection that occurs usually in debilitated or immune suppressed patients. Intracranial lesions such as cerebral ischemia mostly develop secondary to vascular injuries like thrombosis of cavernous sinus or internal carotid artery and also from arteritis. However, intracranial hemorrhage complicated by mucormycosis is very rare. We report a patient with a fatal complicaton of intracranial hemorrhage presumably due to arteritis by mucormycosis. A 66-year-old female patient with uncontrolled diabetes mellitus developed complete ophthalmoplegia in her left eye for two days. Rhinoscopic examination revealed black necrotic turbinate. Orbital CT scan and Brain MRI showed soft tissue material at the left orbital apex and mild deformities in the left lateral cavernous sinus. On the basis of radiological evidence and biopsy, a diagnosis of mucormycosis was established, and the patient underwent surgical debridement followed by an Amphotericin B infusion. On the following day, she suddenly developed a right hemiparesis and stupor. An immediate brain CT scan revealed a large intracranial hemorrhage in the left frontal head region. Removal of the hematoma and a biopsy was performed immediately. A pathological examination revealed a fungal invasion of the small arterial wall and an acute inflammatory reaction of the surounding tissues.