Meningitis

Abstract

Meningitis is defined as inflammation of the meninges, in almost all cases identified by an abnormal number of white blood cells in the cerebrospinal fluid and specific clinical signs/symptoms. Onset may be acute or chronic, and clinical symptoms of acute disease develop over hours to days. This article reviews the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of acute meningitis, and provides a list of key points for primary care practitioners. Aseptic and bacterial meningitis vary significantly and are discussed separately.

Cerebrospinal Fluid in Clinical Neurology

“…If intracranial pressure is suspected, the placement of an ICP probe is indispensable; if ICP remains elevated or cerebral perfusion pressure is dangerously low (<50 mmHg), immediate follow-up neuroimaging is mandatory. Greenblatt et al ( 2013 ), Putz et al ( 2013 ), Ross ( 2014 ) Encephalitic brain oedema may be diffuse or focal; however, anti-oedematous therapy with corticosteroids or osmotherapy is still a matter of discussion. No prospective randomised trials with respect to corticosteroids or osmotherapy exist for viral encephalitides.…”

“…14.1 Epstein-Barr virus encephalitis with life-threatening diffuse brain oedema, successful bilateral decompressive craniectomy similar to Japanese encephalitis (30 %). Patients who survive an encephalitis or a myelitis have a likelihood of >10 % to suffer from severe neurological long-term sequelae, paraplegia or tetraplegia and epilepsy as well as focal or diffuse encephalopathies being the major long-term sequelae in patients with severe encephalitis and/or myelitis (Nigrovic 2013 ;Putz et al 2013 ;Ross 2014 ;Zhang et al 2014 ).…”

“…Modifi ed according toBrouwer et al ( 2013 ),Franzen-Rohl et al ( 2008), Nigrovic ( 2013,Putz et al ( 2013 ),Ross ( 2014 ) CSF cerebrospinal fl uid, PCR polymerase chain reaction, RT-PCR reverse transcription-polymerase chain reaction a Fourfold or greater increase in IgG between acute and convalescent sera Patients with viral meningitis do not need specifi c antiviral therapy; however, the best possible symptomatic care, e.g. analgesics, anti-emetics, etc., is essential.…”

“…Clinical observation supplements the acute care. Specifi c antivirals or the administration of hyperimmunoglobulins is not recommended in a case with pure viral meningitis (DeSouza and Madhusudana 2014 ;Nigrovic 2013 ;Putz et al 2013 ;Ross 2014 ).…”

“…2a Viral causes of meningitis(Franzen-Rohl et al 2008 ;Handique and Handique 2011 ;Huang and Shih 2014 ;Nicolasora and Kaul 2008 ;Nigrovic 2013 ;Putz et al 2013 ) …”