Aseptic meningitis after intrathecal baclofen injection

Bensmaïl, Djamel; Peskine, Anne; Denys, Pierre; Bernard, Louis; Bussel, B.

doi:10.1038/sj.sc.3101838

Cited by 17 publications

(6 citation statements)

References 28 publications

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“…Table 4 lists the noninfectious causes of chronic meningitis and additional central nervous system manifestations, ranging from invasion into the meninges of malignant cells, autoimmune disease, septic embolic processes, and foreign bodies, to so-called idiopathic chronic meningitis, reflecting a so far not yet understood inflammatory process of the meninges [5,8,10,13,22,24,26,27,31]. Table 5 also lists the most important chemical substances which have been reported to elicit irritation/inflammation of the meninges [3,6,7,10,14,29,30,31,33,34,38]. …”

Section: Pathogenetic Mechanisms and Etiologiesmentioning

confidence: 98%

Chronic meningitis

Helbok

Broessner²,

Pfausler³

et al. 2009

J Neurol

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Chronic meningitis is an inflammation of the meninges with subacute onset and persisting cerebrospinal fluid (CSF) abnormalities lasting for at least one month. Several non-infectious and infectious etiologies are known to be causative. The wide range of different etiologies renders the approach to patients with this syndrome particularly difficult. There is no standardized diagnostic procedure, thus, taking an in depth history combined with a complete physical examination is mandatory in every patient.This review aims to present the current knowledge on etiology, neurological course of disease, diagnostic and therapeutic management steps of patients presenting with clinical signs and symptoms of chronic meningitis and meningoencephalitis. Still, the etiology of one third of patients remains unclear, reflecting the diagnostic challenge of this syndrome for each physician or neurologist, respectively. However, most patients with idiopathic chronic meningitis have a relatively good outcome.

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Section: Pathogenetic Mechanisms and Etiologiesmentioning

confidence: 98%

Chronic meningitis

Helbok

Broessner²,

Pfausler³

et al. 2009

J Neurol

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“…Numerous other molecules have been suspected of being responsible for DIAMs, such as allopurinol [86,87], azathioprine [88], cytarabine [89,90], salazopyrine [91,92], and intramuscular methotrexate [93]. Chemical meningitis is a particular entity described after the intrathecal injection of a large number of molecules such as radiographic agents [30], corticosteroids [94][95][96][97][98][99], aminoglycosides [100], bupivacain [101][102][103], morphine [23], interferon (IFN) [24], and baclofene [22,104]. Three categories could be suspected [105] as follows: infection, chemical irritation, and patient-specific reaction(s).…”

Section: Miscellaneousmentioning

confidence: 99%

“…First one is a direct toxicity of the administered drug. Using intrathecal route increases the risk of meningitis, depending on the concentration of drug, the size of its particles, or its ability to cross lipidic brain barriers. The second mechanism suggested is an immunological hypersensitivity reaction that may be further subdivided into type I to type IV hypersensitivity .…”

Section: Pathophysiology Of Diammentioning

confidence: 99%

“…Without excluding an immune mechanism, the authors strongly suggested a direct stimulus of the meninges to explain the five episodes of DIAM, leading to subacute sclerosing panencephalitis contrasting with the good prognostic of classical DIAMs. Site‐specific phlogistic properties have also been reported after intrathecal injection of baclofene, although oral administrations were safe, but ineffective, in the same patients , thus, questioning if a history of chemical meningitis constitutes a contraindication to baclofene pump indication.…”

Section: Identification Of Causative Agents Involved In Diammentioning

confidence: 99%

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Drug‐induced aseptic meningitis: a mini‐review

Yéléhé‐Okouma

Czmil-Garon

Pape

et al. 2018

Fundamemntal Clinical Pharma

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Aseptic meningitis associates a typical clinical picture of meningitis with the absence of bacterial or fungal material in the cerebrospinal fluid. Drug-induced aseptic meningitis (DIAM) may be due to two mechanisms: (i) a direct meningeal irritation caused by the intrathecal administration of drugs and (ii) an immunologic hypersensitivity reaction to a systemic administration. If the direct meningeal irritation allows a rather easy recognition, the immunologic hypersensitivity reaction is a source of challenging diagnostics. DIAM linked to a systemic treatment exerts typically an early onset, usually within a week. This period can be shortened to a few hours in case of drug rechallenge. The fast and spontaneous regression of clinical symptoms is usual after stopping the suspected drug. Apart from these chronological aspects, no specific clinical or biological parameters are pathognomonic. CSF analysis usually shows pleiocytosis. The proteinorachia is increased while glycorachia remains normal. Underlying pathologies can stimulate the occurrence of DIAM. Thus, systemic lupus erythematosus appears to promote DIAM during NSAID therapy, especially ibuprofen-based one. Similarly, some patients with chronic migraine are prone to intravenous immunoglobulin-induced aseptic meningitis. DIAM will be mainly evoked on chronological criteria such as rapid occurrence after initiation, rapid regression after discontinuation, and recurrence after rechallenge of the suspected drug. When occurring, positive rechallenge may be very useful in the absence of initial diagnosis. Finally, DIAM remains a diagnosis of elimination. It should be suggested only after all infectious causes have been ruled out.

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“…1 It has been theorized to be caused by a hypersensitivity reaction or by direct meningeal irritation. [2][3][4] It is characterized by lack of infectious etiology and by improvement in a few days without use of antibiotics. CSF (cerebrospinal fluid) analysis reveals pleocytosis typically of polymorphonuclear predominance but may be of lymphocytic or eosinophilic predominance as well; additionally, the CSF protein is usually elevated while the glucose level remains within normal limits.…”

Section: Introductionmentioning

confidence: 99%