viral meningitis
TRANSCRIPT
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Viral Meningitis
Dr. Nagula Praveen
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Frontal or retrorbital headachePhotphobiaPain on moving the eyesTerminal neck rigidityProfound alterations in consciousness –think of viral
encephalitisSeizures,focal neurological disturbances --unsual
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ETIOLOGY
Can be known by CSF analysis,CSF PCR,culture,serologyMost imp ..ENTERO viruses,HSV -2 ,arboviruses.2/3 CSF culture negative are positive by CSF PCR.
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CSF analysis
Lymphocytic pleocytosis 25-500 cells/ul Thousands LCMVNormal or raised proteinsNormal glucoseNormal or mild elevated CSF pressureDecreased glucose –think of Mumps,LCMV.PMNs dominate – echovirus 9,EEE,mumpsFor 1 week –WNVCSF oligoclonal bands –viral,multiple
sclerosis,neuorsyphilis,borreliosis
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Differential diagnosis
Partially treated bacterial meningitisEarly fungal,tuberculosisMycoplasma,listerianoeplastic
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ENTERO VIRUS
Most common>75% casesCSF RT PCR – diagnosisSummer monthsRx is supportiveStigmata of enterovirus -
herpangina,plurodynia,myopericarditis,hemorrhagic conjunctivitis.
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ARBO viruses
Cluster of cases
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others
HSV 2 More in womenSecond MC in adultsMost common cause of recurrent meningitis
VZV – concurrent chicken pox,shingles
EBV –cannot be cultured from CSF
Mumps – lifelong immunity once episode treated
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Treatment
SupportiveAnalegiscsAntipyreticsAntiemeticsFluid balanceOral/IV acylcovir –HSV,VZV,EBV15-30mg/kg/day in 3 divided doses.PLECORANIL
FULL RECOVERY IS THE RULE USUALLY
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LEPTOMENINGEALMETASTASES
CARCINOMATOUS MENINGITIS
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CARCINOMA BREAST,lymphoma,leukemiaInfiltration of cranial,spinal nerves,direct invasion of
brain,spinal cord,obstructive hydrocephalus --- multiple neuro defects
Cytology may show malignant cellsSpinal tap should be done twice before saying negativeCT scan –contrast enhancement in basal cisterns,showing
hydorcephalus without mass lesionMyelography –deposits over multiple nerve rootsRx – irradiation,intrathecal methotrexate.Poor prognosis –10 % surivival for 1 yr
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Mollaret meningitis
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Mollaret's meningitis is a recurrent inflammation of the protective membranes covering thebrain and spinal cord, known collectively as the meninges. It is a recurrent, benign, aseptic meningitis.
Recurrent episodes of severe headache, meningismus, and fever; cerebrospinal fluid (CSF) pleocytosis with large "endothelial" cells, neutrophils, and lymphocytes; and attacks separated by symptom-free periods of weeks to months; and spontaneous remission of symptoms and signs.
Many people have side effects between bouts that vary from chronic daily headaches to after-effects from meningitis such as hearing loss. Some patients report short bouts of 3–7 days of being sick while others have cases that can last for weeks or months.
Although historically Mollaret's meningitis did not have a causative agent, it is now believed to be mostly from herpetic infection.
CNS epidermoid cysts can give rise to Mollaret's meningitis especially with surgical manipulation of cyst contents.
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Chronic meningtis
With no improvement over a period of 4 weeksNonifectiousinfectious
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TO BE COMPLETED…….
CEREBRAL MALARIABRAIN ABSCESSNEUROTUBERCULOSISNUEROCYSTICERCOSISSSPEBENIGN INTRACRANIAL HYPERTENSIONHYDROCEPHALUSPSEUDOTUMOR CEREBRIASTROCYTOMACORTICAL VENOUS THROMBOSIS
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To be completed
1.CEREBRAL MALARIA2.SSPE3.HYDROCEPHALUS4.CSF circulation5.benign intracranial hypertension6.pseudotumor cerebri7.neurocysticercosis8.neurotuberculosis9.brain abscess10.cortical sinus venous thrombosis
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