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Aseptic meningitis in adults

R Paul Johnson, MD
Section Editor
Martin S Hirsch, MD
Deputy Editor
Jennifer Mitty, MD, MPH


The term aseptic meningitis refers to patients who have clinical and laboratory evidence for meningeal inflammation with negative routine bacterial cultures. The most common cause is enterovirus [1]. Additional etiologies include other infections, (mycobacteria, fungi, spirochetes), parameningeal infections, medications, and malignancy (table 1) [2].

Aseptic meningitis often has a similar presentation to bacterial meningitis (eg, fever, headache, altered mental status, stiff neck, photophobia), which can be a life-threatening illness. However, in contrast to bacterial meningitis, the majority of patients with aseptic meningitis have a self-limited course that will resolve without specific therapy.

The assessment of patients with probable aseptic meningitis is complicated by the large number of potential etiologic agents and the relatively limited diagnostic tools for identifying specific pathogens. (See "Clinical features and diagnosis of acute bacterial meningitis in adults" and "Herpes simplex virus type 1 encephalitis".)

The symptoms, signs, and cerebrospinal fluid (CSF) findings for various etiologies of aseptic meningitis will be reviewed here. Each diagnostic entity is discussed in detail separately on the appropriate topic reviews.


The presence or absence of normal brain function is the important distinguishing feature between encephalitis and meningitis. Patients with meningitis may be uncomfortable, lethargic, or distracted by headache, but their cerebral function remains normal. In encephalitis, however, abnormalities in brain function are common, including altered mental status, motor or sensory deficits, altered behavior and personality changes, and speech or movement disorders. Seizures and postictal states can be seen with meningitis alone and should not be construed as definitive evidence of encephalitis. Other neurologic manifestations include hemiparesis, flaccid paralysis, and paresthesias.


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Literature review current through: Sep 2016. | This topic last updated: Sep 28, 2012.
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