This document discusses chronic meningitis, which is defined as meningitis lasting over 4 weeks with persistent inflammation in cerebrospinal fluid. The main causes are infectious agents like tuberculosis, fungi, viruses, or parasites. Non-infectious causes include malignancy, autoimmune disorders, chemical meningitis, or parameningeal infections. The approach involves analyzing CSF, identifying underlying infections or conditions, and potentially a meningeal biopsy. Proper diagnosis is important to determine appropriate treatment and management of chronic meningitis.

1. Chronic and
Recurrent
Meningitis
Prepared By:
DR.KUCHA

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. 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. Five categories of disease
account for most cases o
chronic meningitis
(1) meningeal infections
(2) malignancy
(3) noninfectious inflammatory disorders
(4) chemical meningitis, and
(5) parameningeal infections.

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. Symptoms & signs Of chronic
meningitis
SYMPTOMS SIGNS
Chronic headache +/– Papilledema
Neck or back pain Brudzinski's sign
Facial weakness Peripheral seventh CN palsy
Double vision Palsy of CNs III, IV, VI
Visual loss Papilledema, optic atrophy
Hearing loss Eighth CN palsy
Arm or leg weakness Myelopathy or radiculopathy
Numbness in arms or legs Myelopathy or radiculopathy
Clumsiness Ataxia

7. APPROACH TO THE PATIENT
WITH 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. APPROACH TO THE PATIENT WITH CHRONIC MENINGITIS
 Proper analysis of the CSF is essential; if the
possibility of raised intracranial
pressure (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. 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. 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. 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