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Viral meningitis

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  • 1. Viral Meningitis
    Dr. Nagula Praveen
  • 2. Frontal or retrorbital headache
    Photphobia
    Pain on moving the eyes
    Terminal neck rigidity
    Profound alterations in consciousness –think of viral encephalitis
    Seizures,focal neurological disturbances --unsual
  • 3. ETIOLOGY
    Can be known by CSF analysis,CSFPCR,culture,serology
    Most imp ..ENTERO viruses,HSV -2 ,arboviruses.
    2/3 CSF culture negative are positive by CSF PCR.
  • 4.
  • 5. CSF analysis
    Lymphocytic pleocytosis 25-500 cells/ul
    Thousands LCMV
    Normal or raised proteins
    Normal glucose
    Normal or mild elevated CSF pressure
    Decreased glucose –think of Mumps,LCMV.
    PMNs dominate – echovirus 9,EEE,mumps
    For 1 week –WNV
    CSF oligoclonal bands –viral,multiplesclerosis,neuorsyphilis,borreliosis
  • 6. Differential diagnosis
    Partially treated bacterial meningitis
    Early fungal,tuberculosis
    Mycoplasma,listeria
    noeplastic
  • 7. ENTERO VIRUS
    Most common
    >75% cases
    CSF RT PCR – diagnosis
    Summer months
    Rx is supportive
    Stigmata of enterovirus -herpangina,plurodynia,myopericarditis,hemorrhagic conjunctivitis.
  • 8. ARBO viruses
    Cluster of cases
  • 9. others
    HSV 2
    More in women
    Second MC in adults
    Most common cause of recurrent meningitis
    VZV – concurrent chicken pox,shingles
    EBV –cannot be cultured from CSF
    Mumps – lifelong immunity once episode treated
  • 10. Treatment
    Supportive
    Analegiscs
    Antipyretics
    Antiemetics
    Fluid balance
    Oral/IV acylcovir –HSV,VZV,EBV
    15-30mg/kg/day in 3 divided doses.
    PLECORANIL
    FULL RECOVERY IS THE RULE USUALLY
  • 11. LEPTOMENINGEALMETASTASES
    CARCINOMATOUS MENINGITIS
  • 12. CARCINOMA BREAST,lymphoma,leukemia
    Infiltration of cranial,spinalnerves,direct invasion of brain,spinalcord,obstructive hydrocephalus --- multiple neuro defects
    Cytology may show malignant cells
    Spinal tap should be done twice before saying negative
    CT scan –contrast enhancement in basal cisterns,showinghydorcephalus without mass lesion
    Myelography –deposits over multiple nerve roots
    Rx – irradiation,intrathecalmethotrexate.
    Poor prognosis –
    10 % surivival for 1 yr
  • 13. Mollaret meningitis
  • 14. 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.
  • 15. Chronic meningtis
    With no improvement over a period of 4 weeks
    Nonifectious
    infectious
  • 16. TO BE COMPLETED…….
    CEREBRAL MALARIA
    BRAIN ABSCESS
    NEUROTUBERCULOSIS
    NUEROCYSTICERCOSIS
    SSPE
    BENIGN INTRACRANIAL HYPERTENSION
    HYDROCEPHALUS
    PSEUDOTUMOR CEREBRI
    ASTROCYTOMA
    CORTICAL VENOUS THROMBOSIS
  • 17. To be completed
    1.CEREBRAL MALARIA
    2.SSPE
    3.HYDROCEPHALUS
    4.CSF circulation
    5.benign intracranial hypertension
    6.pseudotumor cerebri
    7.neurocysticercosis
    8.neurotuberculosis
    9.brain abscess
    10.cortical sinus venous thrombosis
    THANK YOU
    THANK YOU