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Case study explores stroke, meningitis link

Aug. 1, 2013, 9:30 AM

A case series by researchers at Vanderbilt University Medical Center examines three patients transferred here with ischemic stroke who later received a diagnosis of fungal meningitis attributed to tainted injections for low back pain, part of a multi-state outbreak.

Daniel Claassen, M.D., M.S.

“We observed cases that presented with classic strokes, but over time evolved to represent fungal meningitis,” said Daniel Claassen, M.D., M.S., assistant professor of Neurology. “We wanted to highlight atypical presentations of fungal meningitis that presented as acute stroke.”

Published online July 22 in JAMA Neurology, the three cases involved one male and two females, all in their 70s, who were seen by Vanderbilt Neurology Stroke and Consultation Services.

These cases highlight the diagnostic dilemma neurologists face because fungal meningitis may present as an acute stroke in patients with typical stroke risk factors.

Claassen said these cases present strong evidence to include meningitis as a differential diagnosis in patients who have received epidural steroid injections.

These three cases were part of a national meningitis outbreak linked to epidural injections of contaminated methylprednisolone. To date, there have been 749 cases of meningitis, including 61 deaths. Of those, 153 cases and 15 deaths occurred in Tennessee.

The case series notes that this is not the first fungal meningitis outbreak due to spinal injections of contaminated steroids, and high suspicion should be raised in for possible fungal meningitis in patients who present with stroke after receiving a recent spinal injection.

“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 study notes.

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