Tainted lots of injectable steroids not only triggered a nationwide outbreak of fungal meningitis late last year, they were also responsible for at least three cases of stroke, according to new research.
Autopsies performed on two deceased stroke victims and tests on a third survivor showed that fungal infections were likely responsible for blocked, or ischemic, blood vessels, according to a paper published Monday in JAMA Neurology.
Physicians at Vanderbilt University Medical Center in Nashville examined the cases of three patients who were admitted with stroke symptoms two weeks to a month after receiving tainted injections of methylprednisolone acetate.
The patients, who were all in their 70s, were each admitted with mild or acute stroke symptoms that grew progressively worse over days. Only a 70-year-old woman who was quickly treated with powerful antifungal medication survived, according to lead author Dr. Daniel Claassen and colleagues.
Study authors determined that the fungal infections caused small blood vessels within the base and rear portions of the brain to become inflamed, constricting or stopping blood flow to regions that controlled speech and coordination, among other functions.
Authors noted that the patients did not yet show symptoms of fungal meningitis when they arrived at the hospital. They also had at least one risk factor for stroke, such as high blood pressure, high cholesterol or the buildup of arterial plaque.
The study warned that physicians should suspect possible fungal infection if a stroke patient had received a recent epidural spinal injection.
"These cases highlight a diagnostic dilemma for neurologists," the authors concluded.
"It is now apparent that a high index of suspicion should be raised for possible fungal meningitis in patients who present with posterior circulation ischemic strokes after receiving a recent epidural spinal injection."
According to the U.S. Centers for Disease Control and Prevention, at least 61 deaths have been linked to three lots of tainted steroids produced by the New England Compounding Center, of Massachusetts.
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