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Viral Meningitis<br />Dr. Nagula Praveen <br />
Frontal or retrorbital headache<br />Photphobia<br />Pain on moving the eyes<br />Terminal neck rigidity<br />Profound alt...
ETIOLOGY<br />Can be known by CSF analysis,CSFPCR,culture,serology<br />Most imp ..ENTERO viruses,HSV -2 ,arboviruses.<br ...
CSF analysis<br />Lymphocytic pleocytosis 25-500 cells/ul<br />Thousands LCMV<br />Normal or raised proteins<br />Normal g...
Differential diagnosis<br />Partially treated bacterial meningitis<br />Early fungal,tuberculosis<br />Mycoplasma,listeria...
ENTERO VIRUS<br />Most common<br />>75% cases<br />CSF RT PCR – diagnosis<br />Summer months<br />Rx is supportive<br />St...
ARBO viruses<br />Cluster of cases<br />
others<br />HSV 2 <br />More in women<br />Second MC in adults<br />Most common cause of recurrent meningitis<br />VZV – c...
Treatment <br />Supportive<br />Analegiscs<br />Antipyretics<br />Antiemetics<br />Fluid balance<br />Oral/IV acylcovir –H...
LEPTOMENINGEALMETASTASES<br />CARCINOMATOUS MENINGITIS<br />
CARCINOMA BREAST,lymphoma,leukemia<br />Infiltration of cranial,spinalnerves,direct invasion of brain,spinalcord,obstructi...
Mollaret meningitis<br />
Mollaret's meningitis is a recurrent inflammation of the protective membranes covering thebrain and spinal cord, known col...
Chronic meningtis<br />With no improvement over a period of 4 weeks<br />Nonifectious<br />infectious<br />
TO BE COMPLETED…….<br />CEREBRAL MALARIA<br />BRAIN ABSCESS<br />NEUROTUBERCULOSIS<br />NUEROCYSTICERCOSIS<br />SSPE<br />...
To be completed<br />1.CEREBRAL MALARIA<br />2.SSPE<br />3.HYDROCEPHALUS<br />4.CSF circulation<br />5.benign intracranial...
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Viral meningitis

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Viral meningitis

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

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