Subsequently trigeminal nerve and adjacent brain may be involved. This is classically found in mucormycosis where blackish necrotic areas are seen in the palate and nasal turbinates. Aspergillosis or mucormycosis may produce sudden onset of deficit due to vasculitis. Rarely there is SAH due to mycotic aneurismal bleed. Unlike bacterial aneurysms, fungus affects the larger arteries.
Suspicion is the first step.
CSF Exam reveals higher proteins, lower glucose and higher mononuclear leucocytosis. CSF may be positive for fungi and cultures may be positive, but take a long time. Candida takes few days, Cryptococci 7 days, while histoplasma and coccidiodes may take 6 weeks. Specific agents commonly used are Amphotericin B, flucytosine and azole derivatives. The duration is for 4-6 weeks till active systemic or CNS infection has disappeared.