this presentation covers the detailed information about the non-infectious meningitis and its pathology, epidemiology, causes, mechanism and its clear pathophysiology. have a glance to know more about it . thank you...

1. NON-INFECTIOUS MENINGITIS
Presented by
T. Mounika Gayathri
M.S.PHARM
NIPER

2. 2
CONTENTS
Introduction
Epidemiology
Aetiology
Risk factors
Pathophysiology
Symptoms
Diagnosis
Prevention
Summary

3. Inflammation of layers of tissue that cover the brain and spinal cord and the fluid filled spaces
between the meninges.
From Greek word, Meninx “ Membrane ’’
itis “ inflammation ’’
In shortly, An inflammation of meninges.
As it is non-infectious , it cannot spread from one person to another.
These are uncommon causes of meningitis.
WHAT IS NON-INFECTIOUS MENINGITIS ???
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4. CLASSIFICATION OF MENINGITIS
• Anatomically, 2 types, MENINGITIS
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Pachymeningitis Leptomeningitis
• Affects dura mater
• Less common
• Affects Pia mater and
Arachnoid layer and Sub
arachnoid space.
• More common

5. EPIDEMIOLOGY
• Very rare, occurs only in less population.
• No racial differences are reported.
• Affect in any patient population, but more seen in neonates.
• Rates of morbidity and mortality are low.
• About 5 of every 100 people suffering with cancer have chance of
developing non-infectious meningitis.
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Source:- Nicolsi A, Hauser WA, Beghi E, Kurland LT. Epidemology of central nervous system infections, J Infect Dis.
2015, 154(3); 399-408.

6. TB Meningitis, 11%,
bacterial meningitis 14%,
Encephalitis, 40%
Non infectious
meningitis, 2%,
other CNS infections,
12%,
Sepsis, 6%
Febrile convulsions,
5%
Viral meningitis, 6%
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Source:- Management of acute meningitis, Michael J Griffiths, Fiona Mc Gill, Tom Solomon, Clin Med, 2018 Apr;
18(2):164-169.

7. Auto immune
disorders
• Systematic lupus
erythematous
Drug induced
• NSAID’S
• Antibiotics
• Immunomodulators
• Intrathecal
injections
Malignancy
• Lymphoma
• Leukemia
• Skin cancer
• Lung cancer
Others
• Chemicals
• Brain surgery
• Head injury
CAUSES
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8. RISK
FACTORS
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Extremes of age :- < 5 or >60 years
Trauma or Neurosurgery or intracranial manipulations
Skipping vaccinations:-
who hasn’t completed the recommended childhood or adult
vaccination schedule.
 Compromised immune system:-
AIDS, alcoholism, Diabetes, use of immunosuppressant
drugs in organ transplantation cases and other factors affects the
immune system , makes more susceptible to meningitis.
 Cancer
Source:- Tunkel AR, Hartman BJ, Kalpan Sl, Kaufman BA, Roos KL, Scheld WM, WhitelY rj, Practice
guidelines for management of bacterial meningitis, Clinical infectious diseases, 39(9):1267-84.

9. DRUG-INDUCED MENINGITIS
Several drugs are known to be the cause, but association with NSAIDS and the
drugs injected directly in to the CSF are more frequent.
The exact pathogenesis is still not known.
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PATHOPHYSIOLOGY
Source:- Jolles S, Sewell WA, Leighton C, Drug-induced aseptic meningitis: Diagnosis and
management, Drug Saf. 2014, 22(3):215-226.

10. There are 2 proposed mechanisms for drug induced meningitis.
1.Direct chemical irritation of the meninges by intrathecal agents.
2.Applies for the non-intrathecal medications (which crosses the BBB), is not
well understood.
It is based on the assumption that the drug produces the acute hypersensitivity
reaction by forming the complex with antibodies in the serum, inturn activating
the complement cascade.
It may reoccur with re-exposure to the offending agent.
10Source:- Green MA, Abraham MN, Horn AJ, Yates TE, Sharma A, Lamotrigene-induced aseptic meningitis,
International Clinical Psychopharmacology, 2010, 24(3):159-161.

11. MALIGNANCY INDUCED MENINGITIS
• Called as Leptomeningeal metastases, which means that cancer spread to the
tissues covering the brain.
• Carcinomatous meningitis can happen in Liquid tumours (Lymphoma or
Leukemia) and Solid tumours ( Breast cancer, skin cancer , lung cancer etc..).
• About 5 out of every 100 people who have a solid tumour develop
carcinomatous meningitis.
• More common in people with leukemia or lymphoma.
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Source:- Management of acute meningitis., Michael J Griffiths, Fiona Mc Gill, Tom Solomon, Clin Med,
2018 Apr; 18(2):164-169.

12. HOW IT
CAUSES?????
Cancer cells can reach the meninges by travelling in
the blood stream from a cancer.
Or it might spread from a secondary cancer that has
already developed in the brain.
TREATMENT
May resolve with successful treatment of cancer
through chemotherapy.
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13. OTHER NON-INFECTIOUS CAUSES
• Anatomical defects and brain surgery can result in open wounds or spaces which make
it easier for bacteria to directly infect the meninges.
• By some auto immune disorders like SLE leads to decreased immunity and makes more
susceptible to meningitis.
• This condition is treated by use of corticosteroids.
• In some cases, no treatment is required because the condition can resolve on its own.
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14. SYMPTOMS
IN
INFANTS
Same as like bacterial
meningitis.
But are milder and may
develop slowly (by this we
can differentiate between
non-infectious and bacterial)
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• A bulge in the soft spot on top of a baby’s head
• Inactivity 14

15. •SYMPTOMS
IN
ADULTS
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Combinely called as
CLASSIC TRIAD
Papilledema is also
seen
Sudden onset of fever
Stiff neck
Altered mental status
Source:- Blog.global-patienttransfer.com

16. NEUROIMAGING
SPINAL TAPANALYSIS
CSF CULTURE
CHEST X-RAY
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DIAGNOSIS
BLOOD TESTS

17. CT Scan
MRI is done at first
to detect if pressure within the skull is increased or that a brain cyst or other
mass in the brain is the cause.
X-rays of the chest or sinuses may also show infection in other areas that may
be associated with meningitis.
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18. SPINAL TAPAND ANALYSIS OF CSF :- (invasive method)
Done after the ICP is lowered or if no mass is detected in CT or MRI scan.
The hollow needle is inserted into dural space and lumbar puncture is done to
obtain the sample (CSF).
Samples analyzed :- Sugar levels
Protein levels
Number of WBC (indicates Pleocytocis)
Presence of any bacteria ( By culturing the fluid )
Cloudy CSF indicates the increase in Proteins, WBC. 18

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 Can cause a life threatening disorder called Brain herniation.
 Due to a sudden decrease in the pressure in the spinal cord caused by
removal of CSF.
 Occurs when something inside the skull produces pressure that moves
the brain tissues.
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20. 20
Increased Protein ( 1000mg/dl)
Increased WBC number ( 5 WBC per mm)
Low sugar levels ( 25 mg/dL)
Absence of bacteria
Indicates
Non-
Infectious
meningitis

21. PREVENTION
• Careful medication history.
• Avoid exposing to chemicals.
• Complete vaccination during childhood.
• Early detection of cancer and must give appropriate treatment.
• Improve immunity by getting enough rest, exercising regularly and eating
some vegetables which are rich in anti-oxidants.
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23. SUMMARY
• Non-infectious meningitis occurs very rarely.
• It is non-fatal when compared with other types of meningitis.
• If the patient is treated with correct treatment, it can be resolved within few weeks.
• Sometimes, no treatment is required as it can resolve on its own.
• As prevention is better than cure, follow some prevention methods like exercising
regularly, eating healthy food etc. to avoid non-infectious meningitis.
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