Viral Meningitis

Dr. Nagula Praveen

Frontal or retrorbital headachePhotphobiaPain on moving the eyesTerminal neck rigidityProfound alterations in consciousness –think of viral

encephalitisSeizures,focal neurological disturbances --unsual

ETIOLOGY

Can be known by CSF analysis,CSF PCR,culture,serologyMost imp ..ENTERO viruses,HSV -2 ,arboviruses.2/3 CSF culture negative are positive by CSF PCR.

CSF analysis

Lymphocytic pleocytosis 25-500 cells/ul Thousands LCMVNormal or raised proteinsNormal glucoseNormal or mild elevated CSF pressureDecreased glucose –think of Mumps,LCMV.PMNs dominate – echovirus 9,EEE,mumpsFor 1 week –WNVCSF oligoclonal bands –viral,multiple

sclerosis,neuorsyphilis,borreliosis

Differential diagnosis

Partially treated bacterial meningitisEarly fungal,tuberculosisMycoplasma,listerianoeplastic

ENTERO VIRUS

Most common>75% casesCSF RT PCR – diagnosisSummer monthsRx is supportiveStigmata of enterovirus -

herpangina,plurodynia,myopericarditis,hemorrhagic conjunctivitis.

ARBO viruses

Cluster of cases

others

HSV 2 More in womenSecond MC in adultsMost common cause of recurrent meningitis

VZV – concurrent chicken pox,shingles

EBV –cannot be cultured from CSF

Mumps – lifelong immunity once episode treated

Treatment

SupportiveAnalegiscsAntipyreticsAntiemeticsFluid balanceOral/IV acylcovir –HSV,VZV,EBV15-30mg/kg/day in 3 divided doses.PLECORANIL

FULL RECOVERY IS THE RULE USUALLY

LEPTOMENINGEALMETASTASES

CARCINOMATOUS MENINGITIS

CARCINOMA BREAST,lymphoma,leukemiaInfiltration of cranial,spinal nerves,direct invasion of

brain,spinal cord,obstructive hydrocephalus --- multiple neuro defects

Cytology may show malignant cellsSpinal tap should be done twice before saying negativeCT scan –contrast enhancement in basal cisterns,showing

hydorcephalus without mass lesionMyelography –deposits over multiple nerve rootsRx – irradiation,intrathecal methotrexate.Poor prognosis –10 % surivival for 1 yr

Mollaret meningitis

Mollaret's meningitis is a recurrent inflammation of the protective membranes covering thebrain and spinal cord, known collectively as the meninges. It is a recurrent, benign, aseptic meningitis.

Recurrent episodes of severe headache, meningismus, and fever; cerebrospinal fluid (CSF) pleocytosis with large "endothelial" cells, neutrophils, and lymphocytes; and attacks separated by symptom-free periods of weeks to months; and spontaneous remission of symptoms and signs.

Many people have side effects between bouts that vary from chronic daily headaches to after-effects from meningitis such as hearing loss. Some patients report short bouts of 3–7 days of being sick while others have cases that can last for weeks or months.

Although historically Mollaret's meningitis did not have a causative agent, it is now believed to be mostly from herpetic infection.

 CNS epidermoid cysts can give rise to Mollaret's meningitis especially with surgical manipulation of cyst contents.

Chronic meningtis

With no improvement over a period of 4 weeksNonifectiousinfectious

TO BE COMPLETED…….

CEREBRAL MALARIABRAIN ABSCESSNEUROTUBERCULOSISNUEROCYSTICERCOSISSSPEBENIGN INTRACRANIAL HYPERTENSIONHYDROCEPHALUSPSEUDOTUMOR CEREBRIASTROCYTOMACORTICAL VENOUS THROMBOSIS

To be completed

1.CEREBRAL MALARIA2.SSPE3.HYDROCEPHALUS4.CSF circulation5.benign intracranial hypertension6.pseudotumor cerebri7.neurocysticercosis8.neurotuberculosis9.brain abscess10.cortical sinus venous thrombosis

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