2. outline
Introduction
Fivecategories of disease account for most
cases chronic meningitis
Two clinical forms of chronic meningitis
Symptoms & signs Of chronic meningitis
APPROACH TO THE PATIENT WITH CHRONIC
MENINGITIS
CAUSES OF CHRONIC MENINGITIS
Infectious
Non infectious
3. Introduction
The
condition is most commonly diagnosed
when :
1) a characteristic neurologic syndrome exists
for > 4 weeks
2) and is associated with a persistent
inflammatory response in the cerebrospinal
fluid (CSF) (white blood cell count
>5/microLitres).
4. Five categories of disease
account for most cases o
chronic meningitis
(1) meningeal infections
(2) malignancy
(3) noninfectious inflammatory disorders
(4) chemical meningitis, and
(5) parameningeal infections.
5. Two clinical forms of chronic
meningitis
1) symptoms are chronic and persistent
2) there are recurrent, discrete episodes
with complete resolution of meningeal
inflammation between episodes without specific
therapy.
6. Symptoms & signs Of chronic
meningitis
SYMPTOMS SIGNS
Chronic headache +/– Papilledema
Neck or back pain Brudzinski's sign
Facial weakness Peripheral seventh CN palsy
Double vision Palsy of CNs III, IV, VI
Visual loss Papilledema, optic atrophy
Hearing loss Eighth CN palsy
Arm or leg weakness Myelopathy or radiculopathy
Numbness in arms or legs Myelopathy or radiculopathy
Clumsiness Ataxia
7. APPROACH TO THE PATIENT
WITH CHRONIC MENINGITIS
Once chronic meningitis is confirmed
by CSF examination, effort is focused
on identifying the cause by:
(1) further analysis of the CSF
(2) diagnosis of an underlying systemic
infection or noninfectious inflammatory
condition, or
(3) examination of meningeal biopsy
8. APPROACH TO THE PATIENT WITH CHRONIC MENINGITIS
Proper analysis of the CSF is essential; if the
possibility of raised intracranial
pressure (ICP) exists, a brain imaging study
should be performed before LP.
Inpts with communicating hydrocephalus
caused by impaired resorption of CSF, LP is
safe and may lead to temporary improvement.
However, if ICP is elevated because of a mass
lesion, brain swelling, or a block in ventricular
