Aseptic meningitis. A local experience

Abstract

Background: Aseptic meningitis is a serous inflammation of meninges, with lymphocyte-predominant pleocytosis in the cerebrospinal fluid. Clinical manifestations include acute headache, meningeal signs and fever, in a patient with no septic appearance. Prognosis depends on the subjacent cause.Objective: Review the epidemiological and clinical characteristics of adult patients diagnosed with aseptic meningitis. Describe CSF findings, and etiologic study performed.Patients and methods: Over a 6 months period, 9 patients with confirmed aseptic meningitis were included. Data was obtained from medical records. Patients with normal CSF, not evaluated by a neurologist or imaging suggesting other diagnosis, were excluded. IRB approval was obtained.Results: 7 cases were women. Mean age was 37 years. Main symptom was headache. 2 cases presented some degree of impairment of consciousness. 1/3 had neck stiffness. None had fever or rash. 2/3 had normal Leukocytes and CRP. Mean WCC was 98 cel/mm3 (with >95% monocytes); mean CSF protein 0,98 g/L, and 2 cases had CSF/serum glucose ratio of <0,4. In only 3 patients, viral PCR was performed, of which 1 was positive for HSV-2. One case was diagnosed with carcinomatous meningitis, and 2 cases with autoimmune etiology. 4 patients were treated with intravenous acyclovir.Conclusion: Aseptic meningitis occurred mostly in young adults. No patient presented fever and few had meningeal irritation signs. Most had normal systemic inflammatory parameters. There was insufficient etiologic study; only in 1/3 of the cases viruses were investigated. Acyclovir may be overused. Etiological study is needed, to rationalize use of antiviral and establish prognosis. Background: Aseptic meningitis is a serous inflammation of meninges, with lymphocyte-predominant pleocytosis in the cerebrospinal fluid. Clinical manifestations include acute headache, meningeal signs and fever, in a patient with no septic appearance. Prognosis depends on the subjacent cause. Objective: Review the epidemiological and clinical characteristics of adult patients diagnosed with aseptic meningitis. Describe CSF findings, and etiologic study performed. Patients and methods: Over a 6 months period, 9 patients with confirmed aseptic meningitis were included. Data was obtained from medical records. Patients with normal CSF, not evaluated by a neurologist or imaging suggesting other diagnosis, were excluded. IRB approval was obtained. Results: 7 cases were women. Mean age was 37 years. Main symptom was headache. 2 cases presented some degree of impairment of consciousness. 1/3 had neck stiffness. None had fever or rash. 2/3 had normal Leukocytes and CRP. Mean WCC was 98 cel/mm3 (with >95% monocytes); mean CSF protein 0,98 g/L, and 2 cases had CSF/serum glucose ratio of <0,4. In only 3 patients, viral PCR was performed, of which 1 was positive for HSV-2. One case was diagnosed with carcinomatous meningitis, and 2 cases with autoimmune etiology. 4 patients were treated with intravenous acyclovir. Conclusion: Aseptic meningitis occurred mostly in young adults. No patient presented fever and few had meningeal irritation signs. Most had normal systemic inflammatory parameters. There was insufficient etiologic study; only in 1/3 of the cases viruses were investigated. Acyclovir may be overused. Etiological study is needed, to rationalize use of antiviral and establish prognosis.