Evaluation and Treatment of Chronic Meningitis

Overview

Journal Neurohospitalist

Publisher Sage Publications

Date 2014 Nov 1

PMID 25360204

Citations 12

Authors

Kelly J Baldwin

Joseph R Zunt

Affiliations

Soon will be listed here.

Abstract

Chronic meningitis is defined as an inflammatory cerebrospinal fluid (CSF) profile that persists for at least 1 month. The presentation often includes headache, nausea, vomiting, cranial neuropathies, symptoms of elevated intracranial pressure, or focal neurologic deficits. The most common etiologies of chronic meningitis fall into 3 broad categories: infectious, autoimmune, and neoplastic. Evaluation of the patient with suspected chronic meningitis should include a detailed history and physical examination as well as repeated CSF diagnostics, serologic studies, and biopsy of the brain or other abnormal tissue (eg, lymph node or lung), when indicated. Early identification of the etiology and rapid treatment are crucial for improving morbidity and mortality, but potential infectious and neoplastic conditions should be excluded prior to empirically starting steroids or immunosuppressive medications.

Citing Articles

Neurosarcoidosis, Coccidioidomycosis, or Both!.

Akhavanrezayat A, Matsumiya W, Ongpalakorn P, Ghoraba H, Or C, Khojasteh Jafari H Int Med Case Rep J. 2024; 16:887-895.

PMID: 38164515 PMC: 10758176. DOI: 10.2147/IMCRJ.S434632.

Clinical Reasoning: A Teenager With Chronic Meningitis-Does Occam's Razor Apply?.

Pavuluri H, Kv V, Thomas B, Vilanilam G, Nair P, Narasimhaiah D Neurology. 2023; 100(17):828-835.

PMID: 36746637 PMC: 10136020. DOI: 10.1212/WNL.0000000000206783.

Evaluation of the epidemiologic, clinical, radiologic, and treatment methods of patients with subacute and chronic meningitis.

Bineshfar N, Rezaei A, Mirahmadi A, Shokouhi S, Javandoust Gharehbagh F, Haghighi M BMC Neurol. 2022; 22(1):340.

PMID: 36088290 PMC: 9463760. DOI: 10.1186/s12883-022-02873-1.

Helicobacter pylori and Epstein-Barr Virus Coinfection Stimulates Aggressiveness in Gastric Cancer through the Regulation of Gankyrin.

Kashyap D, Baral B, Jakhmola S, Singh A, Jha H mSphere. 2021; 6(5):e0075121.

PMID: 34585958 PMC: 8550222. DOI: 10.1128/mSphere.00751-21.

Chronic Meningitis.

Thakur K, Wilson M Continuum (Minneap Minn). 2018; 24(5, Neuroinfectious Disease):1298-1326.

PMID: 30273241 PMC: 6812559. DOI: 10.1212/CON.0000000000000664.

References

van der Horst C, Saag M, Cloud G, Hamill R, Graybill J, Sobel J . Treatment of cryptococcal meningitis associated with the acquired immunodeficiency syndrome. National Institute of Allergy and Infectious Diseases Mycoses Study Group and AIDS Clinical Trials Group. N Engl J Med. 1997; 337(1):15-21. DOI: 10.1056/NEJM199707033370103. View

Marra C, Tantalo L, Maxwell C, Dougherty K, Wood B . Alternative cerebrospinal fluid tests to diagnose neurosyphilis in HIV-infected individuals. Neurology. 2004; 63(1):85-8. DOI: 10.1212/01.wnl.0000131902.69113.34. View

Herbrecht R, Denning D, Patterson T, Bennett J, Greene R, Oestmann J . Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002; 347(6):408-15. DOI: 10.1056/NEJMoa020191. View

Fragoso-Loyo H, Cabiedes J, Orozco-Narvaez A, Davila-Maldonado L, Atisha-Fregoso Y, Diamond B . Serum and cerebrospinal fluid autoantibodies in patients with neuropsychiatric lupus erythematosus. Implications for diagnosis and pathogenesis. PLoS One. 2008; 3(10):e3347. PMC: 2556096. DOI: 10.1371/journal.pone.0003347. View

Woodworth G, McGirt M, Williams M, Rigamonti D . The use of ventriculoperitoneal shunts for uncontrollable intracranial hypertension without ventriculomegally secondary to HIV-associated cryptococcal meningitis. Surg Neurol. 2005; 63(6):529-31. DOI: 10.1016/j.surneu.2004.08.069. View

Thwaites G, Caws M, Chau T, Dung N, Campbell J, Phu N . Comparison of conventional bacteriology with nucleic acid amplification (amplified mycobacterium direct test) for diagnosis of tuberculous meningitis before and after inception of antituberculosis chemotherapy. J Clin Microbiol. 2004; 42(3):996-1002. PMC: 356903. DOI: 10.1128/JCM.42.3.996-1002.2004. View

Nozaki K, Judson M . Neurosarcoidosis. Curr Treat Options Neurol. 2013; 15(4):492-504. DOI: 10.1007/s11940-013-0242-9. View

AlRawi A, Trobe J, Blaivas M, Musch D . Brain biopsy in primary angiitis of the central nervous system. Neurology. 1999; 53(4):858-60. DOI: 10.1212/wnl.53.4.858. View

Viscoli C, Machetti M, Gazzola P, De Maria A, Paola D, Van Lint M . Aspergillus galactomannan antigen in the cerebrospinal fluid of bone marrow transplant recipients with probable cerebral aspergillosis. J Clin Microbiol. 2002; 40(4):1496-9. PMC: 140329. DOI: 10.1128/JCM.40.4.1496-1499.2002. View

10.

Mitchell T, Perfect J . Cryptococcosis in the era of AIDS--100 years after the discovery of Cryptococcus neoformans. Clin Microbiol Rev. 1995; 8(4):515-48. PMC: 172874. DOI: 10.1128/CMR.8.4.515. View

11.

Gascon-Bayarri J, Mana J, Martinez-Yelamos S, Murillo O, Rene R, Rubio F . Neurosarcoidosis: report of 30 cases and a literature survey. Eur J Intern Med. 2011; 22(6):e125-32. DOI: 10.1016/j.ejim.2011.08.019. View

12.

Joseph F, Lammie G, Scolding N . CNS lupus: a study of 41 patients. Neurology. 2007; 69(7):644-54. DOI: 10.1212/01.wnl.0000267320.48939.d0. View

13.

Ginat D, Dhillon G, Almast J . Magnetic resonance imaging of neurosarcoidosis. J Clin Imaging Sci. 2011; 1:15. PMC: 3173834. DOI: 10.4103/2156-7514.76693. View

14.

Thomas A, Korb V, Guillemain R, Caruba T, Boussaud V, Billaud E . Clinical outcomes of lung-transplant recipients treated by voriconazole and caspofungin combination in aspergillosis. J Clin Pharm Ther. 2010; 35(1):49-53. DOI: 10.1111/j.1365-2710.2009.01061.x. View

15.

Prasad K, Singh M . Corticosteroids for managing tuberculous meningitis. Cochrane Database Syst Rev. 2008; (1):CD002244. DOI: 10.1002/14651858.CD002244.pub3. View

16.

Joseph F, Scolding N . Sarcoidosis of the nervous system. Pract Neurol. 2007; 7(4):234-44. DOI: 10.1136/jnnp.2007.124263. View

17.

Thwaites G, Chau T, Farrar J . Improving the bacteriological diagnosis of tuberculous meningitis. J Clin Microbiol. 2004; 42(1):378-9. PMC: 321694. DOI: 10.1128/JCM.42.1.378-379.2004. View

18.

Pepper D, Marais S, Maartens G, Rebe K, Morroni C, Rangaka M . Neurologic manifestations of paradoxical tuberculosis-associated immune reconstitution inflammatory syndrome: a case series. Clin Infect Dis. 2009; 48(11):e96-107. DOI: 10.1086/598988. View

19.

Kim J, Kim K, Yoon H, Kwok S, Ju J, Park K . Meningitis in Korean patients with systemic lupus erythematosus: analysis of demographics, clinical features and outcomes; experience from affiliated hospitals of the Catholic University of Korea. Lupus. 2011; 20(5):531-6. DOI: 10.1177/0961203310384495. View

20.

FLOOD J, Weinstock H, Guroy M, Bayne L, Simon R, Bolan G . Neurosyphilis during the AIDS epidemic, San Francisco, 1985-1992. J Infect Dis. 1998; 177(4):931-40. DOI: 10.1086/515245. View