Síndrome meníngeo crónico. Afectación meníngea de etiología no infecciosa

Abstract

Noninfectious chronic meningitis (NICM) is defined as meningeal inflammation unrelated to an infectious process that progresses with signs and symptoms which persist for more than four weeks. The most common clinical manifestation is headache in varying combinations with altered mental status, focal neurological signs, fever, nuchal rigidity, myelopathy, cranial neuropathies, or polyradiculopathies. The approach to NICM begins with a medical history, full physical examination, and additional tests (serological tests, brain imaging tests, lumbar puncture, and biopsy of skin lesions and lymph nodes). Cerebral and meningeal biopsy can be considered in cases that progress with progressive neurological decline and an inconclusive systemic or CSF study. Systemic diseases with meningeal involvement tend to progress with a combination of chronic or relapsing chronic meningitis and uveitis (uveo-meningeal syndromes). For the initial treatment, high doses of corticosteroids and, in refractory cases, immunosuppressants are required. Neoplastic meningitis presents with both solid tumors and with malignant cerebral and hematological neoplasms; its treatment depends on the type of neoplasm. The drugs most commonly associated with NICM are intravenous non-steroidal anti-inflammatory drugs, sulfamides, penicillins, and immunoglobulins. The prognosis is good, with improvement after withdrawal of the drug implicated.