Approach to the patient with chronic meningitis
- Daniel J Sexton, MD
Daniel J Sexton, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine
- Duke University Medical Center
Meningitis can be classified on the basis of its underlying cause, type of inflammatory response, or the time course of the illness. Based upon the time course, meningitis is defined as acute or chronic. The onset of symptoms of acute meningitis typically is abrupt with progression over hours, but some patients become ill over several days, especially when early symptoms are not appreciated. (See "Clinical features and diagnosis of acute bacterial meningitis in adults".)
Acute meningitis due to infectious causes usually does not recur. However, a small number of patients with acute meningitis may develop recurrent attacks between intervals of good health. (See "Approach to the adult with recurrent infections", section on 'Meningitis'.)
Chronic meningitis is arbitrarily defined as meningitis lasting for four weeks or more and is a complex entity with both infectious and noninfectious causes [1-7]. Although some authors attempting to define the syndrome of chronic meningitis have excluded patients with meningitis occurring concurrently with mass lesions of the central nervous system, meningitis associated with previously diagnosed systemic diseases known to cause meningitis, and meningitis following neurosurgical procedures, this definition may be too restrictive for clinical purposes . Patients with chronic meningitis usually have a subacute onset of symptoms including fever, headache, and vomiting. The symptoms can remain static, fluctuate, and/or slowly worsen. The symptoms and clinical course of chronic meningitis vary widely from patient to patient.
The differential diagnosis, clinical evaluation, prognosis, and management strategies for patients with chronic meningitis, including those in whom a diagnosis cannot be established with routine tests, will be reviewed here. Individual conditions associated with chronic meningitis are discussed separately. (See related topics.)
LIMITATIONS OF THE LITERATURE
Because of its rarity and the diversity of causes, the literature on chronic meningitis consists largely of case reports and a small number of retrospective case series from single centers. Selection, publication, and ascertainment biases greatly limit the utility of this literature for assessing the relative proportions of patients with any given etiologic diagnosis and for assessing the natural history of individual patients with chronic meningitis.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- LIMITATIONS OF THE LITERATURE
- CLINICAL FEATURES
- CSF examination and other laboratory testing
- Imaging studies
- Role of meningeal or brain biopsy
- MANAGEMENT OF PATIENTS WITH CHRONIC MENINGITIS OF UNKNOWN CAUSE
- Role of empiric therapy
- - Antituberculous therapy
- - Glucocorticoids
- - Antifungal therapy
- MIMICS OF CHRONIC MENINGITIS
- SUMMARY AND RECOMMENDATIONS