Nursing College

1. Diagnosis and differential
diagnosis of Meningitis

2. Diagnosis of Meningitis
• Clinically by clinical presentations of sings,
symptoms and physical examination.
• Laboratory investigations
• Blood examinations
CBC
Blood culture
Blood sugar test

3. Diagnosis of Meningitis
• LP for CSF analysis (culture & Gram’s staining)
- It is the definitive test , has the major rule for
the diagnosis and rule out other possibilities.
Figure1

4. Diagnosis of Meningitis
• The CSF abnormalities. Table1
Table 1:defference between bacterial and viral CSF abnormalities
Viral abnormalities
Bacterial abnormalities
Lymphocytic pleocytosis
Polymorpjonuclear(PMN)
leukocytosis pleocytosis
CSF Cells
Normal or slight elevation
Increased
Protein concentation
Normal
Decreased
Glucose concentration
Generally poor
Positive in> 80% of patients
CSF culture
Organisms are not seen
Demonstrate organisms in > 60%
CSF Gram’s staining

5. Diagnosis of Meningitis
• PCR amplification of Nucleic Acid
The most important method for diagnosing CNS
viral infections.
Detect bacterial DNA.
• Neuroimaging (CT, MRI)
- It is used to detect a shift in brain content
(Herniation),perform prior LP if there are recent
head trauma, decrease consciousness, papilledema,
focal neurologic deficit, or seizures.

6. Differential Diagnosis
• Brain abscess
• Brain tumor
• Encephalitis
• Delirium tremens
• Subarachnoid hemorrhage
• Rickettsial disease
• Subdural, epidural empyema
• Neurosyphilis
• Parameningeal infections
• SLE
• Rheumatologic disease
• Sarcoidosis
• Uveomeningitic syndrome
• Medication-induced hypersensitivity meningitis