Meningitis-retention Syndrome Research Articles

A Case of HSV-2 Meningitis Retention Syndrome (P12-10.004)

<h3>Objective:</h3> Not applicable <h3>Background:</h3> Meningitis Retention Syndrome (MRS) is a rare disorder characterized by the development of urinary retention in the context of aseptic meningitis with CSF pleocytosis¹. In many cases, no underlying cause is determined, but pathogens such as mycobacteria, listeria, EBV and HSV-2 have been reported as causative agents in the literature². The underlying pathophysiology remains unclear, but possible causes have been suggested including spinal shock secondary to meningeal irritation, sacral myeloradiculitis due to direct viral inflammation, or a post-infectious acute disseminated encephalomyelitis process^3,4. We discuss here an unusual case of a young man presenting for urinary retention who was found to have HSV-2 meningitis. <h3>Design/Methods:</h3> <h3>Case report:</h3> A 17-year-old male with chronic constipation presented to the emergency department for urinary retention of 2 days duration. He endorsed the sensation to void with an inability to empty his bladder despite straining in the setting of a two-week history of mild headaches, diffuse back pain, myalgias and low-grade fevers. He was non-toxic appearing and neurological exam was normal. Abdominal X-ray showed a moderate stool burden. Spine MRI demonstrated subtle enhancement of the cauda equina. CSF evaluation were notable for an elevated opening pressure to 34 mmHg and a lymphocytic pleocytosis (693 white blood cells), and elevated protein of 60. Multiplex panel for central nervous system infections by polymerase chain reaction was positive for HSV-2. He was admitted to the hospital for IV acyclovir and management of urinary retention. <h3>Results:</h3> Not applicable <h3>Conclusions:</h3> This case demonstrated the importance of keeping meningitis retention syndrome on the differential for individuals presenting with acute urinary retention after a viral infection. Keeping a high index of suspicion is crucial, especially in cases like the one described where the patient only had some vague viral symptoms but no obvious meningeal signs, radicular pains or genital ulcers. <b>Disclosure:</b> Dr. Aoun has nothing to disclose. Dr. Raj Ghosh has nothing to disclose. Dr. Kuball has nothing to disclose. The institution of Dr. Abreu has received research support from Adult Polyglucosan Body Disease Research Foundation. The institution of Dr. Abreu has received research support from Sanofi Genzyme. The institution of Dr. Abreu has received research support from Takeda. The institution of Dr. Abreu has received research support from Sangamo.

Elsberg Syndrome with Mixed Presentation as Meningitis Retention Syndrome: A Pediatric Case Report and Comprehensive Review of the Literature

Elsberg syndrome is a typically infectious syndrome that may cause acute or subacute bilateral lumbosacral radiculitis and sometimes lower spinal cord myelitis. Patients often present with various neurological symptoms involving the lower extremities, including numbness, weakness, and urinary disturbances such as retention. A 9-year-old girl with no significant past medical history presented with altered mental status, fever, urinary retention, and anuria and was found to have encephalomyelitis. An extensive diagnostic workup led to ruling out possible etiologies until identifying Elsberg syndrome. In this report, we describe a case of Elsberg syndrome caused by West Nile virus (WNV). To the best of our knowledge, this is the first reported case of its kind in the pediatric population. Utilizing PubMed and Web of Science databases, we reviewed the literature to describe the neurogenic control of the urinary system in correlation to a multitude of neurologic pathologies.

Urinary Retention Suggesting Aseptic Meningitis: Meningitis-Retention Syndrome Without Physical Signs of Meningeal Irritation.

Meningitis-retention syndrome (MRS) is the combination of aseptic meningitis and acute urinary retention that occurs in the absence of other neurological diseases. The cause(s) of MRS remain unclear. A 57-year-old Japanese woman was referred to our hospital for the evaluation of persistent fever and headache. The fever's cause was initially unclear, but the presence of urinary retention raised concern about possible aseptic meningitis despite no physical indications of meningeal irritation. Only typical cases of MRS have been reported thus far to our knowledge, and it is important that clinicians are aware of MRS when it presents in this atypical form.

Meningitis retention syndrome caused by varicella zoster virus in a patient without a rash: a case report

BackgroundMeningitis retention syndrome (MRS) is a rare condition that presents with acute urinary retention as a complication of aseptic meningitis. Cases of MRS due to varicella zoster virus (VZV) infection without a rash are rare. We report the case of a patient who had no signs of meningitis or VZV infection, including a rash.Case presentationA 58-year-old man presented with dysesthesia of the lower limbs and acute urinary retention. He had fever but no rash and no signs of meningitis. He was diagnosed to have VZV infection based on the detection of VZV DNA in the cerebrospinal fluid. He responded satisfactorily to a course of intravenous acyclovir and experienced no sequelae during a 2-year follow-up period.ConclusionMRS due to aseptic meningitis of viral origin should be considered in the differential diagnosis of acute urinary retention even in the absence of specific signs and symptoms of meningitis or a suggestive rash.

Meningitis-retention syndrome with reference to mild cases

Meningitis-retention syndrome with reference to mild cases

Epstein-Barr Virus-induced Meningitis-Retention Syndrome.

Meningitis-retention syndrome (MRS) is a rare disorder where aseptic meningitis is accompanied by urinary retention, which can be easily misdiagnosed as urinary tract infection.MRS should be considered when examining patients with fever and urinary retention, as dysuria may precede the meningitis symptoms.The presence of Epstein-Barr virus can also complicate MRS.

Meningitis Retention Syndrome in an 11-Year-Old Boy: A Case Report of an Underreported Clinical Scenario in Children

Meningitis retention syndrome (MRS) is an underreported clinical syndrome in children that presents with meningitis and acute retention of urine. It is usually associated with aseptic meningitis, but there are case reports of MRS associated with viral and other kind of meningitis. There is no imaging abnormalities in the brain and spine associated with acute urinary retention. Here we report a case of an 11-year-old boy who presented with signs of meningism and acute urinary retention. Further evaluation revealed features of meningitis in cerebrospinal fluid analysis and normal imaging of the brain and spine. He completely recovered from urinary retention after meningitis treatment. Keywords: Meningitis; Urinary Retention; Child; Case Report

Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders.

Multiple sclerosis (MS), neuromyelitis optica (NMO), and related disorders are major immune-mediated central nervous system diseases affecting the spinal cord. We reviewed the occurrence of neurogenic lower urinary tract dysfunction (NLUTD) in these categories of diseases. We systematically reviewed the literature regarding bladder dysfunction in MS, NMO spectrum disorder (NMOSD), and related disorders (acute disseminated encephalomyelitis, acute immune-mediated myelopathy, and meningitis-retention syndrome). The literature, although somewhat limited for diseases other than MS, suggests that bladder dysfunction is not uncommon in these diseases, presumably reflecting lesions in the spinal descending and ascending pathways. The pattern of bladder dysfunction is a combination of overactive bladder and large post-void residuals/urinary retention. Post-void residual is measured by portable ultrasound devices. Because of the complexity of bladder behavior, careful consideration of bladder management is necessary in MS, NMO, and related disorders: e.g., antimuscarinics, etc., for overactive bladder and clean, intermittent self-catheterization for urinary retention. These management practices should help improve patients' quality of life.

Meningitis-retention syndrome: Clinical features, frequency and prognosis

BackgroundMeningitis-retention syndrome (MRS) is a peculiar combination of aseptic meningitis (AM) and acute urinary retention without other neurological symptoms. MRS has not been well recognised, and the prevalence of MRS in patients with AM is unknown. ObjectiveTo investigate the frequency and clinical features of MRS. MethodsClinical and laboratory features of patients with MRS who were consecutively admitted to the Chiba Rosai Hospital between 2009 and 2017. ResultsOf the 37 patients with AM, MRS was observed in three (8%). In MRS patients, the mean latency between the onset of meningeal symptoms (headache and/or fever) and the three clinical course milestones (the onset of voiding difficulty, urinary retention and recovery of no residual urine volume) were 8, 9.3 and 18 days, respectively. Patients with MRS frequently showed elevated cerebrospinal fluid adenosine deaminase levels and decreased cerebrospinal fluid/serum glucose ratios. All patients with MRS recovered without a specific treatment, and the mean hospital stay was 18 days. ConclusionsMRS may be more common than is generally considered. The long-term prognosis of MRS was good, and it was a self-limiting condition. However, it is likely to be underreported or misdiagnosed. Therefore, it is important to recognise that patients with AM may have MRS.

Cystometrography of meningitis-retention syndrome

Although the combination of acute urinary retention and aseptic meningitis has not been well recognised, this combination can be referred to as meningitis-retention syndrome (MRS). We report a case of...

尿閉で発症した無菌性髄膜炎，meningitis-retention syndromeの1例

髄膜炎尿閉症候群（meningitis-retention syndrome：MRS）は無菌性髄膜炎に尿閉を合併する疾患であるが，今回，尿閉が初期症状であった症例を経験した．50代女性が排尿障害を発症，後に発熱を来たし，尿路感染として入院加療を開始したところ，悪心嘔吐が出現，髄液検査で無菌性髄膜炎が診断され，排尿障害は尿閉であったことから，MRSと診断された．MRSは尿閉を初期症状として発症し得るため，原因不明の急性尿閉を来たす疾患としてMRSを念頭に置く必要がある．

Meningitis retention syndrome - Case report

Background: Urinary retention is a common presenting complaint in Emergency Department. Meningitis can be an unusual cause for this. This combination is referred to as Meningitis Retention Syndrome (MRS). We present 2 cases of MRS diagnosed in A&amp;E, Alkhor. Case 1: A 43-year-old male presented to ED with low grade fever, head ache of 10 days and dysuria of 2 days duration. Examination was unremarkable except for palpable bladder. Examination of CNS was normal. He was discharge on antibiotic after catheterisation of urinary bladder. He was readmitted to ED after few days with worsening of symptoms. Physical examination was unremarkable. CT head (contrast) showed meningeal enhancements and CSF study showed lymphocytic pleocytosis. He was initiated on anti-tubercular treatment (ATT). Patient improved and was discharged. Case 2: A 42-year-old male presented to ED with fever and dysuria. He was managed as a case of urinary tract infection. He was readmitted to ED with fever and urinary retention. Physical examination was unremarkable except for temperature 38.5°C. Blood test and urinalysis were normal. He was discharged on medication. 2 days later he was admitted with altered sensorium high grade fever and clinical features of meningitis. CSF study showed lymphocytic pleocytosis. Patient was initiated on ATT. Patient had a prolonged and stormy hospital stay and later improved. Discussion: Meningitis Retention syndrome is thought to be a very minute form of acute disseminated encephalomyelopathy. Urinary retention might reflect acute shock phase of this disorder. Most of the previously reported cases were due to aseptic meningitis but here we report two cases of MRS due to tuberculous meningitis Acute urinary retention can provide a critical clue to the diagnosis of meningitis as a cause of fever of unknown origin.

Meningitis-Retention Syndrome.

Meningitis-retention syndrome (MRS) is a clinical entity that has recently appeared in the literature. We present the case of a 22-year-old man with fever and headache who, in the course of his hospitalization with a diagnosis of aseptic meningitis, developed acute urinary retention. Fewer than 30 such cases have been described and in several of them, no clear associations with other disorders have been made. In some cases, direct association with viral infection has been proved, and in others, there are indications of an underlying demyelinating condition. To further complicate the issue, various conditions such as Elsberg syndrome and acute disseminated encephalomyelitis, which not only have some similarities but also have some distinct differences, have been placed under the umbrella definition of MRS. In our review, we attempt to address these conditions and better define MRS by establishing diagnostic criteria based on what has thus far been described in the literature.

Meningitis-Retention Syndrome as a Presentation of West Nile Virus Meningitis

A 26-year-old previously healthy man presented with fever, urinary retention, nuchal rigidity, and hyperreflexia but with a clear sensorium. His initial spinal fluid results were consistent with aseptic meningitis from West Nile virus infection, and this was confirmed by serological studies on blood and cerebrospinal fluid. Computed tomography and magnetic resonance imaging studies were unremarkable. He received supportive care and urinary catheterization to prevent bladder injury from overdistension. He was discharged home without recurrence of urinary retention after five days of hospitalization. Therefore, this case report describes the first case of West Nile virus meningitis in a patient with the meningitis-retention syndrome.

“Meningitis‐retention syndrome”: A review

A peculiar combination of acute urinary retention and aseptic meningitis has been described. This combination is referred to as meningitis-retention syndrome (MRS), since patients with this syndrome exhibited no other abnormalities, except for mild pyramidal involvement. We aimed to delineate this syndrome by reviewing literatures. We performed a systematic review of the literature to identify the frequency, clinical symptoms, urodynamic findings, putrative underlying pathology, and management of this syndrome. Patients with MRS have typical symptoms of fever, headache, stiff neck, and minor pyramidal signs, together with acute urinary retention. The bladder is initially areflexic, but soon becomes either normal or overactive in the repeated urodynamics during the course of the disorder. MRS is thought to be a very mild form of acute disseminated encephalomyelopathy (ADEM), with increased cell count, total protein, and occasional myelin basic protein in the cerebrospinal fluid. Proper management of the acute urinary retention is necessary to avoid bladder injury due to overdistension. The effectiveness of immune treatments (e.g., steroid pulse therapy) in shortening the urinary retention period awaits further study. Although rare, MRS is a disorder that both urologists and neurologists may encounter. MRS should be listed in the differential diagnosis of acute urinary retention.

Meningitis retention syndrome

A 50-year-old Caucasian woman presented with signs and symptoms of meningitis preceded by a 3 day history of flu-like symptoms and progressive difficulty with urination. Cerebrospinal Fluid (CSF) analysis was consistent with aseptic meningitis. She was found to have a significant urinary retention secondary to atonic bladder. MRI of the brain and spine were normal and CSF-PCR (polymerase chain reaction) was positive for HSV-2. Urinary retention in the context of meningitis and CSF pleocytosis is known as Meningitis Retention Syndrome (MRS). MRS is a rare but important complication of meningitis most commonly associated with HSV-2. Involvement of central pathways may have a role in the pathogenesis of MRS but this is poorly documented. MRS is different from Elsberg syndrome wherein patients display features of lumbosacral polyradiculitis or radiculomyelitis. Early treatment with antiviral therapy was associated with a favorable outcome in our patient.

Meningitis-retention Syndrome: First Case of Urodynamic Follow-up

The combination of acute urinary retention and aseptic meningitis has not been well recognized. This combination can be referred to as meningitis-retention syndrome (MRS), when accompanied by no other abnormalities. However, the responsible site of lesions for urinary retention in MRS remains obscure, despite the areflexic detrusor at the time of urinary retention. We recently encountered a man with MRS in whom a urodynamic study was performed twice. In that case, an initially areflexic detrusor became overactive after a 4-month period, suggesting an upper motor neuron bladder dysfunction.

Isolated splenial lesion in the corpus callosum in combination with urinary retention in a case of aseptic meningoencephalitis

Aseptic meningoencephalitis in rare instances can present radiologically as a reversible isolated splenial lesion in corpus callosum (Reversible Splenial Lesion Syndrome or RSLS). Patients rarely develop temporary urinary retention, previously described as the meningitis-retention syndrome. We report a case report of a 28-year-old woman with aseptic meningoencephalitis with an unusual combination of RSLS and urinary retention. A complete resolution of neurological symptoms and urinary retention was noted within two months. In cases of aseptic meningoencephalitis, RSLS and urinary retention are good prognostic factors and are associated with complete recovery.

Aseptic Meningitis with Urinary Retention: A Case Report

Introduction. Aseptic meningitis is serious inflammation of the meninges caused by agents including viruses, non-viral pathogens, non-infectious conditions and chemicals. Case Presentation. This study concerns the case of a 16-year-old healthy Greek female with persistent fever, mild headache and acute urinary retention, secondary to aseptic meningitis. Physical examination revealed no distinct signs of meningeal irritation. The urinary bladder was palpable, painless and over-distended. Serology carried out for common viruses was as follows: CMV IgG (−), CMV IgM (−), HSV IgG (−), HSV IgM (+), VZ IgG (+), VZ IgM (−), EBV IgG (−) and EBV IgM (+). During recovery in hospital, three trials of removing a urinary catheter were carried out; during the first two attempts the patient was unable to urinate and had a loss of bladder sensation. On the third attempt the patient had modest bladder perception but she left a post-voiding residual, and was instructed to perform bladder self-catheterization. Seven days after being discharged the patient underwent a full recovery. Conclusion. There are few reports concerning aseptic meningitis together with acute urinary retention. A number of these cases concern so-called “meningitis-retention syndrome,” which implies an underlying CNS mechanism, while others concerned an underlying peripheral nervous system mechanism.

Herbal Medicine-induced Meningitis-retention Syndrome

A 73-year-old woman developed subacute meningitis-retention syndrome (MRS), dermatitis, and latent pneumonitis likely due to the herbal medicines Shinbu-Tou and Rikkunshi-Tou. The responsible site of lesions for urinary retention seemed to be the spinal micturition pathways and, to a lesser extent, the sacral spinal cord. All of her clinical manifestations were successfully ameliorated within three weeks of discontinuation of the herbal remedies.