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Viral meningitis
 

Viral meningitis

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    Viral meningitis Viral meningitis Presentation Transcript

    • Viral Meningitis
      Dr. Nagula Praveen
    • 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
    • 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.
    • 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
    • Differential diagnosis
      Partially treated bacterial meningitis
      Early fungal,tuberculosis
      Mycoplasma,listeria
      noeplastic
    • ENTERO VIRUS
      Most common
      >75% cases
      CSF RT PCR – diagnosis
      Summer months
      Rx is supportive
      Stigmata of enterovirus -herpangina,plurodynia,myopericarditis,hemorrhagic conjunctivitis.
    • ARBO viruses
      Cluster of cases
    • 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
    • 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
    • LEPTOMENINGEALMETASTASES
      CARCINOMATOUS MENINGITIS
    • 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
    • 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 weeks
      Nonifectious
      infectious
    • TO BE COMPLETED…….
      CEREBRAL MALARIA
      BRAIN ABSCESS
      NEUROTUBERCULOSIS
      NUEROCYSTICERCOSIS
      SSPE
      BENIGN INTRACRANIAL HYPERTENSION
      HYDROCEPHALUS
      PSEUDOTUMOR CEREBRI
      ASTROCYTOMA
      CORTICAL VENOUS THROMBOSIS
    • 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