Chronic and recurrent meningitis


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Chronic and recurrent meningitis

  1. 1. Chronic andRecurrentMeningitisPrepared By: DR.KUCHA
  2. 2. outline Introduction Fivecategories of disease account for most cases chronic meningitis Two clinical forms of chronic meningitis Symptoms & signs Of chronic meningitis APPROACH TO THE PATIENT WITH CHRONIC MENINGITIS CAUSES OF CHRONIC MENINGITIS Infectious Non infectious
  3. 3. Introduction The condition is most commonly diagnosed when :  1) a characteristic neurologic syndrome exists for > 4 weeks  2) and is associated with a persistent inflammatory response in the cerebrospinal fluid (CSF) (white blood cell count >5/microLitres).
  4. 4. Five categories of diseaseaccount for most cases ochronic meningitis (1) meningeal infections (2) malignancy (3) noninfectious inflammatory disorders (4) chemical meningitis, and (5) parameningeal infections.
  5. 5. Two clinical forms of chronic meningitis 1) symptoms are chronic and persistent 2) there are recurrent, discrete episodes with complete resolution of meningeal inflammation between episodes without specific therapy.
  6. 6. Symptoms & signs Of chronic meningitis SYMPTOMS SIGNSChronic headache +/– PapilledemaNeck or back pain Brudzinskis signFacial weakness Peripheral seventh CN palsyDouble vision Palsy of CNs III, IV, VIVisual loss Papilledema, optic atrophyHearing loss Eighth CN palsyArm or leg weakness Myelopathy or radiculopathyNumbness in arms or legs Myelopathy or radiculopathyClumsiness Ataxia
  7. 7. APPROACH TO THE PATIENTWITH CHRONIC MENINGITISOnce chronic meningitis is confirmed by CSF examination, effort is focused on identifying the cause by:  (1) further analysis of the CSF  (2) diagnosis of an underlying systemic infection or noninfectious inflammatory condition, or  (3) examination of meningeal biopsy
  8. 8. APPROACH TO THE PATIENT WITH CHRONIC MENINGITIS Proper analysis of the CSF is essential; if the possibility of raised intracranialpressure (ICP) exists, a brain imaging study should be performed before LP. Inpts with communicating hydrocephalus caused by impaired resorption of CSF, LP is safe and may lead to temporary improvement. However, if ICP is elevated because of a mass lesion, brain swelling, or a block in ventricular
  9. 9. INFECTIOUS CAUSES OF CHRONIC MENINGITIS Common Bacterial Causes Helminthic Causes  Partially treated suppurative meningitis Cysticercosis  Parameningeal infection Gnathostoma  Mycobacterium tuberculosis Angiostrongylus  Lyme disease (Bannwarth’s syndrome): Borrelia burgdorferi  Syphilis (secondary, tertiary): Treponema pallidum Fungal Causes Protozoal Causes  Cryptococcus neoformans Toxoplasma gondii
  10. 10. INFECTIOUS CAUSES OF CHRONIC MENINGITIS Viral Causes Mumps HIV (acute retroviral syndrome) Lymphocytic choriomeningitis Herpes simplex (HSV) Echovirus Obstructive hydrocephalus usually requires direct ventricular drainage of CSF.
  11. 11. Noninfectious causes of meningitis Malignancy Chemical compounds(may cause recurrent meningitis) Primary inflammation  CNS sarcoidosis  Systemic lupus erythematosus  Behcet’s syndrome (recurrent meningitis)  Chronic benign lymphocytic meningitis  Drug hypersensitivity  Wegener’s granulomatosis
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