Abstract 439: Transcranial Doppler Monitoring of Cerebral Blood Flow in a Case of Fusarium Solani Meningitis Associated Vasculopathy

Introduction/PurposeThe recent outbreak of nosocomial Fusarium solani (F. solani) meningitis among immunocompetent individuals following cosmetic surgery at two clinics in Matamoros, Mexico, is well documented. Despite initial antifungal treatment, many patients developed severe intracranial vascular complications, particularly involving the posterior circulation, such as stenoses and aneurysms. While traditional imaging like CT‐Angiography and MR‐Angiography are the standard for diagnosing these complications, routine monitoring using these methods is not feasible. This is crucial in F. solani meningitis, as the disease course is dynamic and requires frequent vascular monitoring.MethodsWe present a case where transcranial doppler ultrasound (TCD) was used to monitor intracranial vascular status in a patient with F. solani meningitis. Daily TCD was performed to assess blood flow velocities in anterior and posterior circulation vessels. TCD findings indicated basilar artery stenosis, a hallmark of F. solani meningitis, with dynamic changes in velocities used to guide intervention and post‐intervention monitoring.ResultsA 31‐year‐old female who underwent cosmetic surgery in Matamoros, Mexico, presented with headaches and nausea 4 weeks post‐surgery. Lumbar puncture revealed findings consistent with F. solani meningitis. Despite antifungal therapy, the patient developed leptomeningeal disease and basilar artery stenosis, confirmed by MRI. TCD showed progressively worsening basilar artery flow velocities (127 ‐ 215 cm/s) and basilar artery/vertebral artery (BA/VA) ratios (2.89 ‐ 4.77) suggestive of progressive stenosis. The patient underwent basilar stenting, and post‐intervention TCD demonstrated improved flow velocities and BA/VA ratios. Continued daily TCD monitoring confirmed vessel patency, and the patient was discharged with stable vascular status after a 2‐month hospitalization.ConclusionTCD proved useful in the dynamic monitoring of basilar artery stenosis in F. solani meningitis, guiding both the timing of intervention and ensuring long‐term vascular patency post‐intervention. This case highlights TCD's value as a non‐invasive tool for frequent vascular assessment in patients with fungal and other similar invasive infectious meningitides.