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Fungal meningitis linked to ischemic stroke
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Three patients who presented to a medical center with acute ischemic stroke were found to have fungal meningitis related to contaminated methylprednisolone injections, according to researchers from Vanderbilt University in Nashville, Tenn.
“We highlight that the angioinvasive nature of some fungal species, including Exserohilum, can lead to progressive vascular occlusion,” they wrote in JAMA Neurology. “An awareness of the presentation and vascular sequelae of fungal meningitis in immunocompetent patients should lead to earlier treatment and improved outcomes prior to a definitive diagnosis.”
The first patient was a 78-year-old man who presented with acute-onset left-sided weakness and dysarthria. MRI revealed a small-vessel ischemic infarct of the right anterior superior pons/lower midbrain. The second patient was a 78-year-old woman who presented with subacute complaints of vertigo, nausea and headache. MRI revealed ischemic infarcts of the left lateral pons, superior cerebella peduncle and superior cerebellum. The third patient was a 70-year-old woman who presented with headache, balance difficulty, nuchal rigidity and fever. MRI revealed acute small-vessel right thalamic and internal capsule ischemic strokes.
All of the patients had at least one risk factor for ischemic stroke. The first two patients died. E. rostratum was the presumed cause of death for both patients. All of the patients had received epidural injections of contaminated methylprednisolone.
“Patients with fungal meningitis who present with ischemic strokes may be afebrile, lack signs of meningeal irritation and have traditional stroke risk factors,” the researchers wrote. “In cases in which small-vessel infarctions expands locally or develop new infarctions in the same vascular territory, an atypical pathogenesis should be considered.”
Disclosure: The researchers report no relevant financial disclosures.
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