Teaching NeuroImage: Black Turbinate Sign as an Early Clue of Rhino-Orbital-Cerebral Mucormycosis

A 75-year-old woman presented with a 1-week history of confusion secondary to diabetic ketoacidosis. Four days after she was admitted to the intensive care unit; she developed a visual acuity of no light perception, ptosis, ophthalmoplegia, and classic features of central retinal artery occlusion in the left eye (Figure 1A). The combination of ophthalmoplegia and optic neuropathy localized the lesion to the orbital apex. CT/CTA head demonstrated bilateral anterior frontal lobe ischemia and left-sided invasive sinusopathy (Figure 1B). Brain MRI revealed nonenhancement of the left nasal turbinates (i.e., “black turbinate sign,” Figure 2). Histopathologic analysis confirmed rhino-orbital-cerebral mucormycosis. She died despite surgical debridement and treatment with liposomal amphotericin B.