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| __NOTOC__
| | <div class="mw-customtoggle-x1" style="cursor: pointer; font-weight: bold; color: #0645AD;"> |
| {{Meningitis}}
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| {{CMG}}; {{AE}}{{MehdiP}}
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| ==Overview==
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| The '''meninges''' (singular '''meninx''') is the system of [[Mesothelium|membrane]]s which envelop the [[central nervous system]]. The meninges consist of three layers: the [[dura mater]], the [[arachnoid mater]], and the [[pia mater]]. The primary function of the meninges and of the cerebrospinal fluid is to protect the [[central nervous system]]. '''Meningitis''' is the [[inflammation]] of these protective membranes.<br> Meningitis may have been described in the Middle Ages, but it was first accurately identified by the Swiss Vieusseux (a scientific-literary association) during an outbreak in Geneva, Switzerland in 1805. In 1661, Thomas Willis first described the inflammation of meninges and an epidemic of meningitis. In the 17th century, Robert Whytt provided a detailed explanation of tuberculous meningitis and its stages. This was further elaborated by John Cheyne in the same century. Meningococcal meningitis was than described by Gaspard Vieusseux, Andre Matthey in Geneva and Elisa North in Massachussetes. <br>Meningitis may develop in response to a number of causes, including infectious agents ([[bacteria]], [[viruses]], [[fungi]], or other organisms) or non-infectious causes, such as systemic illnesses that may involve [[CNS]] (e.g. [[neoplasms]] or [[connective tissue diseases]], such as [[sarcoidosis]], [[systemic lupus erythematosus]] (SLE), and [[Granulomatosis with polyangiitis|wegener's]]) or certain drugs (e.g. [[nonsteroidal antiinflammatory drugs]], [[intravenous immunoglobulin]], intrathecal agents, and [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]]). While some forms of meningitis are mild and resolve spontaneously (e.g. viral meningitis), meningitis is a potentially serious condition owing to the proximity of the [[inflammation]] to the [[brain]] and [[spinal cord]]. The potential for serious neurologic damage or even death necessitates prompt medical attention and evaluation. The common presenting features of meningitis are, [[fever]], [[neck stiffness]] and [[headache]]. Other symptoms include, [[photophobia]] (inability to tolerate bright light), [[phonophobia]] (inability to tolerate loud noises), [[irritability]], [[altered mental status]] (in small children), and [[seizure]]. Physical examination of meningitis may vary in adults and infants. In adults, physical examination findings may include [[bradycardia]], [[disorientation]], [[papilledema]], [[neck stiffness]], positive [[Brudzinski's Sign|brudzinski's]] and [[kernig's sign]]. However, [[petechial rash]], bulging [[fontanelle]], [[neck stiffness]], [[jaundice]], and [[convulsions]] are physical examination findings in infants. Diagnosis is based on clinical findings and [[CSF analysis]]. Treatment options are based on etiology and varies from supportive care and observing the patient (viral meningitis) to antibiotic therapy for bacterial meningitis or chemotherapy and/or irradiation for neoplastic meningitis.<ref name="pmid10411200">{{cite journal| author=Attia J, Hatala R, Cook DJ, Wong JG| title=The rational clinical examination. Does this adult patient have acute meningitis? | journal=JAMA | year= 1999 | volume= 282 | issue= 2 | pages= 175-81 | pmid=10411200 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10411200 }} </ref><ref name=abc>https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0047163/ Accessed on Jan 9th, 2017</ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268 }} </ref><ref name="pmid15509818">{{cite journal| author=van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M| title=Clinical features and prognostic factors in adults with bacterial meningitis. | journal=N Engl J Med | year= 2004 | volume= 351 | issue= 18 | pages= 1849-59 | pmid=15509818 | doi=10.1056/NEJMoa040845 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15509818 }} </ref><ref>{{cite journal |author=van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB, Vermeulen M |title=Clinical features and prognostic factors in adults with bacterial meningitis |journal=N. Engl. J. Med. |volume=351 |issue=18 |pages=1849-59 |year=2004 |pmid=15509818 |doi=10.1056/NEJMoa040845}}</ref><ref name="pmid8416268">{{cite journal| author=Durand ML, Calderwood SB, Weber DJ, Miller SI, Southwick FS, Caviness VS et al.| title=Acute bacterial meningitis in adults. A review of 493 episodes. | journal=N Engl J Med | year= 1993 | volume= 328 | issue= 1 | pages= 21-8 | pmid=8416268 | doi=10.1056/NEJM199301073280104 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8416268 }} </ref><ref name="pmid3403999">{{cite journal| author=Domingo P, Mancebo J, Blanch L, Net A, Nolla J| title=Fever in adult patients with acute bacterial meningitis. | journal=J Infect Dis | year= 1988 | volume= 158 | issue= 2 | pages= 496 | pmid=3403999 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3403999 }} </ref><ref name="pmid12060874">{{cite journal| author=Thomas KE, Hasbun R, Jekel J, Quagliarello VJ| title=The diagnostic accuracy of Kernig's sign, Brudzinski's sign, and nuchal rigidity in adults with suspected meningitis. | journal=Clin Infect Dis | year= 2002 | volume= 35 | issue= 1 | pages= 46-52 | pmid=12060874 | doi=10.1086/340979 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12060874 }} </ref>
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| ==Causes==
| | CLICK HERE TO SEE THE CORRECTION |
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| !align="center" style="background:#4479BA; color: #FFFFFF;" |Etiology
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| !align="center" style="background:#4479BA; color: #FFFFFF;" |Common causes
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| !align="center" style="background:#4479BA; color: #FFFFFF;" |Less common causes
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Bacterial
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Streptococcus pneumoniae]]
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| * [[Neisseria meningitis]]
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| * [[Haemophilus influenzae|Hemophilus influenza]]
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| * [[Group B streptococcus]]
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| * [[Listeria monocytogenes]]
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| * [[Staphylococcus aureus]]
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| * [[Klebsiella]]
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| * [[Pseudomonas]]
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| * [[Escherichia coli|E. coli]]
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| * [[Kingella|Kingella Kingae]]
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| * [[Mycobacterium tuberculosis]]
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| * [[Corynebacterium|Diphtheroids]]
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| * [[Propionibacterium acnes]]
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| * [[Serratia marcescens]]
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| * [[Salmonella|Salmonella species]]
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| * [[Brucella|Brucella sp]]
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| * [[Nocardia]]
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| * [[Francisella tularensis]]
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| * [[Streptococcus suis]]
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| * [[Ehrlichia|Ehrlichia chaffeensis]]
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| | </div> |
| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Viral
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Enteroviruses]]
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| * [[Herpes simplex]] [[viruses]] 1 and 2
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| * [[Arboviruses]]
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| * [[Influenza virus]]
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| * [[Herpes zoster]]
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| * [[HHV-6 encephalitis|Human Herpes Virus 6]]
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| * [[Epstein barr virus mononucleosis|Epstein barr virus]] (EBV)
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| * [[Lymphocytic choriomeningitis virus]]
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| * [[Mumps]]
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| * [[Cytomegalovirus|Cytomegalo virus]] (CMV)
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| * [[Human Immunodeficiency Virus (HIV)|Human immunodeficiency virus]] (HIV)
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| * [[West nile virus]]
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| * [[HTLV|Human T cell lymphotrophic virus]] I and II
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| * [[Varicella zoster virus]]
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Fungal
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Cryptococcus neoformans]]
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| *[[Aspergillus]] sp.
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| *[[Blastomyces dermatitidis]]
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| *[[Coccidioides immitis]]
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| *[[Candida]] spp.
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| *[[Histoplasma capsulatum]]
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| *[[Sporothrix schenckii|Sporothrix schencki]]
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| *Xylohypha (formerly [[Cladosporium]]) trichoides and other dark-walled (demateaceous) fungi such as [[Curvularia]] and Drechslera
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| *[[Mucor]]
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| *Arthrographis kalrae
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| *[[Pneumocystis jirovecii]]<ref name="pmid9495679">{{cite journal| author=Villanueva JL, Cordero E, Caballero-Granado FJ, Regordan C, Becerril B, Pachón J| title=Pneumocystis carinii meningoradiculitis in a patient with AIDS. | journal=Eur J Clin Microbiol Infect Dis | year= 1997 | volume= 16 | issue= 12 | pages= 940-2 | pmid=9495679 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9495679 }}</ref><ref name="pmid9629775">{{cite journal| author=Baena Luna MR, Muñoz García J, Grancha Bertolín L, Sanz García M| title=[Presence of Pneumocystis carinii in cerebrospinal fluid]. | journal=An Med Interna | year= 1998 | volume= 15 | issue= 5 | pages= 265-6 | pmid=9629775 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9629775 }}</ref>
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| *[[Cryptococcus]] albidus<ref name="pmid7185917">{{cite journal| author=Melo JC, Srinivasan S, Scott ML, Raff MJ| title=Cryptococcus albidus meningitis. | journal=J Infect | year= 1980 | volume= 2 | issue= 1 | pages= 79-82 | pmid=7185917 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7185917 }}</ref>
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| *[[Alternaria]] spp<ref name="pmid13730495">{{cite journal| author=OHASHI Y| title=On a rare disease due to Alternaria tenuis Nees (alternariasis). | journal=Tohoku J Exp Med | year= 1960 | volume= 72 | issue= | pages= 78-82 | pmid=13730495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=13730495 }}</ref>
| | <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1"> |
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| *[[Rhodotorula]] spp <ref name="pmid18974495">{{cite journal| author=Shinde RS, Mantur BG, Patil G, Parande MV, Parande AM| title=Meningitis due to Rhodotorula glutinis in an HIV infected patient. | journal=Indian J Med Microbiol | year= 2008 | volume= 26 | issue= 4 | pages= 375-7 | pmid=18974495 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18974495 }}</ref>
| | [[image:Passage-4.gif]] |
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| *[[Acremonium]] spp.<ref name="pmid1956281">{{cite journal| author=Fincher RM, Fisher JF, Lovell RD, Newman CL, Espinel-Ingroff A, Shadomy HJ| title=Infection due to the fungus Acremonium (cephalosporium). | journal=Medicine (Baltimore) | year= 1991 | volume= 70 | issue= 6 | pages= 398-409 | pmid=1956281 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1956281 }}</ref>
| | </div> |
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| *Dreschlera spp<ref name="pmid4739938">{{cite journal| author=Fuste FJ, Ajello L, Threlkeld R, Henry JE| title=Drechslera hawaiiensis: causative agent of a fatal fungal meningo-encephalitis. | journal=Sabouraudia | year= 1973 | volume= 11 | issue= 1 | pages= 59-63 | pmid=4739938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=4739938 }}</ref>
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| *[[Malassezia]] spp<ref name="pmid15255040">{{cite journal| author=Rosales CM, Jackson MA, Zwick D| title=Malassezia furfur meningitis associated with total parenteral nutrition subdural effusion. | journal=Pediatr Dev Pathol | year= 2004 | volume= 7 | issue= 1 | pages= 86-90 | pmid=15255040 | doi=10.1007/s10024-003-4030-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15255040 }}</ref>
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| *[[Scedosporium apiospermum|Scedosporium]] spp<ref name="pmid16678041">{{cite journal| author=Symoens F, Knoop C, Schrooyen M, Denis O, Estenne M, Nolard N et al.| title=Disseminated Scedosporium apiospermum infection in a cystic fibrosis patient after double-lung transplantation. | journal=J Heart Lung Transplant | year= 2006 | volume= 25 | issue= 5 | pages= 603-7 | pmid=16678041 | doi=10.1016/j.healun.2005.12.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16678041 }}</ref>
| | CLICK HERE TO SEE THE CORRECTION |
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| *Arthrographis spp<ref name="pmid11158158">{{cite journal| author=Chin-Hong PV, Sutton DA, Roemer M, Jacobson MA, Aberg JA| title=Invasive fungal sinusitis and meningitis due to Arthrographis kalrae in a patient with AIDS. | journal=J Clin Microbiol | year= 2001 | volume= 39 | issue= 2 | pages= 804-7 | pmid=11158158 | doi=10.1128/JCM.39.2.804-807.2001 | pmc=87827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11158158 }}</ref>
| | </div> |
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| *Blastoschizomyces<ref name="pmid1810730">{{cite journal| author=Girmenia C, Micozzi A, Venditti M, Meloni G, Iori AP, Bastianello S et al.| title=Fluconazole treatment of Blastoschizomyces capitatus meningitis in an allogeneic bone marrow recipient. | journal=Eur J Clin Microbiol Infect Dis | year= 1991 | volume= 10 | issue= 9 | pages= 752-6 | pmid=1810730 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1810730 }}</ref><ref name="pmid2324536">{{cite journal| author=Naficy AB, Murray HW| title=Isolated meningitis caused by Blastoschizomyces capitatus. | journal=J Infect Dis | year= 1990 | volume= 161 | issue= 5 | pages= 1041-2 | pmid=2324536 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2324536 }}</ref>
| | <div class="mw-collapsible mw-collapsed" id="mw-customcollapsible-x1"> |
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| *[[Paecilomyces]]<ref name="pmid12588483">{{cite journal| author=Kantarcioğlu AS, Hatemi G, Yücel A, De Hoog GS, Mandel NM| title=Paecilomyces variotii central nervous system infection in a patient with cancer. | journal=Mycoses | year= 2003 | volume= 46 | issue= 1-2 | pages= 45-50 | pmid=12588483 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12588483 }}</ref><ref name="pmid7192726">{{cite journal| author=Fagerburg R, Suh B, Buckley HR, Lorber B, Karian J| title=Cerebrospinal fluid shunt colonization and obstruction by Paecilomyces variotii. Case report. | journal=J Neurosurg | year= 1981 | volume= 54 | issue= 2 | pages= 257-60 | pmid=7192726 | doi=10.3171/jns.1981.54.2.0257 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7192726 }}</ref>
| | [[image:Passage-6.gif]] |
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| *[[Aureobasidium]]<ref name="pmid22504065">{{cite journal| author=Kutleša M, Mlinarić-Missoni E, Hatvani L, Voncina D, Simon S, Lepur D et al.| title=Chronic fungal meningitis caused by Aureobasidium proteae. | journal=Diagn Microbiol Infect Dis | year= 2012 | volume= 73 | issue= 3 | pages= 271-2 | pmid=22504065 | doi=10.1016/j.diagmicrobio.2012.03.007 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22504065 }}</ref>
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| *Clavispora<ref name="pmid10030550">{{cite journal| author=Krcmery V, Mateicka F, Grausova S, Kunova A, Hanzen J| title=Invasive infections due to Clavispora lusitaniae. | journal=FEMS Immunol Med Microbiol | year= 1999 | volume= 23 | issue= 1 | pages= 75-8 | pmid=10030550 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10030550 }}</ref>
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| *[[Ustilago]]<ref name="pmid20991975">{{cite journal| author=MOORE M, RUSSELL WO, SACHS E| title=Chronic leptomeningitis and ependymitis caused by Ustilago, probably U. zeae (corn smut). | journal=Am J Pathol | year= 1946 | volume= 22 | issue= | pages= 761-77 | pmid=20991975 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20991975 }}</ref>
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| *[[Exophiala]] (Wangiella)<ref name="pmid12530707">{{cite journal| author=Centers for Disease Control and Prevention (CDC)| title=Exophiala infection from contaminated injectable steroids prepared by a compounding pharmacy--United States, July-November 2002. | journal=MMWR Morb Mortal Wkly Rep | year= 2002 | volume= 51 | issue= 49 | pages= 1109-12 | pmid=12530707 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12530707 }}</ref>
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| *Exserohilum<ref name="pmid23465119">{{cite journal| author=Pettit AC, Pugh ME| title=Index case for the fungal meningitis outbreak, United States. | journal=N Engl J Med | year= 2013 | volume= 368 | issue= 10 | pages= 970 | pmid=23465119 | doi=10.1056/NEJMc1300630 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23465119 }}</ref>
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Spirochetal
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Treponema pallidum]]
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| * [[Borrelia burgdorferi|Borrelia burgdoferi]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" | --
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Protozoal and Helminthic
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * Amebas (''[[Naegleria]], [[Acanthamoeba]],'' and ''[[Balamuthia mandrillaris|Balamuthia]])''
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Angiostrongylus cantonensis]]
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| * [[Gnathostoma Infection|Gnathostoma species]]
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| * [[Baylisascaris|Baylisascaris procyonis]]
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| * [[Toxocara|Toxocara species]]
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| * [[Taenia solium]]
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| |style="padding: 5px 5px; background: #DCDCDC;" align="center" |Noninfectious conditions
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Neoplastic]]
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| * [[Sarcoidosis]]
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| * [[Systemic lupus erythematosus]]
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| * [[Granulomatosis with polyangiitis]] (Wegener's)
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| * [[Behçet's disease]]
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| |style="padding: 5px 5px; background: #F5F5F5;" align="left" |
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| * [[Fabry's disease|Fabry disease]]
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| * Central nervous system [[vasculitis]]
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| * [[Vogt-Koyanagi-Harada syndrome|Vogt-Koyanagi-Harada disease]]
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| * Chemical or drug-induced meningitis
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| ** [[Nonsteroidal antiinflammatory drugs]]
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| ** [[Intravenous immunoglobulin]]
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| ** [[Intrathecal]] agents
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| ** Certain antibiotics (eg, [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]])
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| |}
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| <br>
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| |}
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| ==Classification==
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| Meningitis could be classified to two main groups based on etiology:
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| *Infectious
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| *Non-infectious
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| ===Infectious meningitis===
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| Infectious meningitis may be classified as the following algorithm based on chronicity of symptoms.<br><br>
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| {{familytree/start}}
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| {{familytree | | | | | | | | | | | | | | | A01 |A01='''Infectious Meningitis'''}}
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| {{familytree | | | | | |,|-|-|-|-|-|-|-|-|-|+|-|-|-|-|-|-|-|-|-|-|-|-|-|-|.| | | }}
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| {{familytree | | | | | B01 | | | | | | | | B02 | | | | | | | | | | | | | B03 | |B01=[[Viral meningitis|Viral]]|B02=[[Bacterial meningitis|Bacterial]]|B03=[[Fungal meningitis|Fungal]]}}
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| {{familytree | | | | | | | | | | | |,|-|-|-|+|-|-|-|.| | | | |,|-|-|-|v|-|^|-|v|-|-|-|.|}}
| |
| {{familytree | | | | | | | | | | | C01 | | C02 | | C03 | | | C04 | | C05 | | C06 | | |C07 |C01=Acute|C02=Chronic|C03=Recurrent|C04=Acute|C05=Subacute|C06=Chronic|C07=Recurrent|}}
| |
| {{familytree/end}}<br>
| |
| | |
| ===Non-infectious meningitis===
| |
| Systemic illnesses, such as malignancies and connective tissue diseases (e.g. [[sarcoidosis]], [[SLE]], and [[Granulomatosis with polyangiitis|wegener's]]) may involve meninges in their course and present as chronic meningitis.
| |
| | |
| Certain drugs may cause meningeal irritation and resemble as meningitis including:
| |
| * [[Nonsteroidal antiinflammatory drugs]] (NSAIDs)
| |
| * [[Intravenous immunoglobulin]]
| |
| * [[Intrathecal]] agents
| |
| * Certain antibiotics (eg, [[Sulfamethoxazole-Trimethoprim|trimethoprim-sulfamethoxazole]])
| |
| | |
| ==Differential diagnosis==
| |
| {|
| |
| |-style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| ! rowspan="2" |<small>Diseases</small>
| |
| ! colspan="4" |<small>Symptoms
| |
| ! colspan="5" |<small>Physical Examination</small>
| |
| ! rowspan="2" |<small>Past medical history</small>
| |
| ! colspan="3" |<small>Diagnostic tests</small>
| |
| ! rowspan="2" |<small>Other Findings</small>
| |
| |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
| |
| !<small>Headache</small>
| |
| !↓<small>LOC</small>
| |
| !<small>Motor weakness</small>
| |
| !<small>Abnormal sensory</small>
| |
| !<small>Motor Deficit</small>
| |
| !<small>Sensory deficit</small>
| |
| !<small>Speech difficulty</small>
| |
| !<small>Gait abnormality</small>
| |
| !<small>Cranial nerves</small>
| |
| !<small>CT /MRI</small>
| |
| !<small>CSF Findings</small>
| |
| !<small>Gold standard test</small>
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Meningitis]]
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' [[Leukocytes]],
| |
| | |
| '''↑''' Protein
| |
| | |
| ↓ Glucose
| |
| | style="background: #F5F5F5; padding: 5px;" |[[CSF analysis]]<ref name="pmid19398286">{{cite journal| author=Carbonnelle E| title=[Laboratory diagnosis of bacterial meningitis: usefulness of various tests for the determination of the etiological agent]. | journal=Med Mal Infect | year= 2009 | volume= 39 | issue= 7-8 | pages= 581-605 | pmid=19398286 | doi=10.1016/j.medmal.2009.02.017 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19398286 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Fever]], [[Neck rigidity|neck]]
| |
| [[Neck rigidity|rigidity]]
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Encephalitis]]
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +/-
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +/-
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +/-
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" |History of [[fever]] and [[malaise]]
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" |'''↑''' [[Leukocytes]], ↓ Glucose
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" |CSF [[PCR]]
| |
| | style="background: #F5F5F5; padding: 5px text-align:center" |[[Fever]], [[Seizure|seizures]], [[Focal neurologic signs|focal neurologic abnormalities]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Brain tumor]]<ref name="pmid10582668">{{cite journal| author=Morgenstern LB, Frankowski RF| title=Brain tumor masquerading as stroke. | journal=J Neurooncol | year= 1999 | volume= 44 | issue= 1 | pages= 47-52 | pmid=10582668 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10582668 }} </ref>
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Weight loss]], [[fatigue]]
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center"| +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Cancer cells<ref name="pmid21371327">{{cite journal| author=Weston CL, Glantz MJ, Connor JR| title=Detection of cancer cells in the cerebrospinal fluid: current methods and future directions. | journal=Fluids Barriers CNS | year= 2011 | volume= 8 | issue= 1 | pages= 14 | pmid=21371327 | doi=10.1186/2045-8118-8-14 | pmc=3059292 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21371327 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |MRI
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Cachexia]], gradual progression of symptoms
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hemorrhagic stroke]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Neck stiffness]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" | [[Subdural hematoma|Subdural hemorrhage]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Trauma]], fall
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px;" |Xanthochromia<ref name="pmid1198628">{{cite journal| author=Lee MC, Heaney LM, Jacobson RL, Klassen AC| title=Cerebrospinal fluid in cerebral hemorrhage and infarction. | journal=Stroke | year= 1975 | volume= 6 | issue= 6 | pages= 638-41 | pmid=1198628 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1198628 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |CT scan without contrast<ref name="pmid21694755">{{cite journal| author=Birenbaum D, Bancroft LW, Felsberg GJ| title=Imaging in acute stroke. | journal=West J Emerg Med | year= 2011 | volume= 12 | issue= 1 | pages= 67-76 | pmid=21694755 | doi= | pmc=3088377 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21694755 }}</ref><ref name="pmid21807345">{{cite journal| author=DeLaPaz RL, Wippold FJ, Cornelius RS, Amin-Hanjani S, Angtuaco EJ, Broderick DF et al.| title=ACR Appropriateness Criteria® on cerebrovascular disease. | journal=J Am Coll Radiol | year= 2011 | volume= 8 | issue= 8 | pages= 532-8 | pmid=21807345 | doi=10.1016/j.jacr.2011.05.010 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21807345 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[dizziness]], [[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Neurosyphilis]]<ref name="pmid22482824">{{cite journal| author=Liu LL, Zheng WH, Tong ML, Liu GL, Zhang HL, Fu ZG et al.| title=Ischemic stroke as a primary symptom of neurosyphilis among HIV-negative emergency patients. | journal=J Neurol Sci | year= 2012 | volume= 317 | issue= 1-2 | pages= 35-9 | pmid=22482824 | doi=10.1016/j.jns.2012.03.003 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22482824 }} </ref><ref name="pmid24365430">{{cite journal |vauthors=Berger JR, Dean D |title=Neurosyphilis |journal=Handb Clin Neurol |volume=121 |issue= |pages=1461–72 |year=2014 |pmid=24365430 |doi=10.1016/B978-0-7020-4088-7.00098-5 |url=}}</ref>
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Sexually transmitted disease|STI]]<nowiki/>s
| |
| |style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px;" |'''↑''' [[Leukocytes]] and [[protein]]
| |
| |style="background: #F5F5F5; padding: 5px;" |CSF [[VDRL]]-specifc
| |
| CSF FTA-Ab -sensitive<ref name="pmid22421697">{{cite journal| author=Ho EL, Marra CM| title=Treponemal tests for neurosyphilis--less accurate than what we thought? | journal=Sex Transm Dis | year= 2012 | volume= 39 | issue= 4 | pages= 298-9 | pmid=22421697 | doi=10.1097/OLQ.0b013e31824ee574 | pmc=3746559 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22421697 }}</ref>
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Blindness]], [[confusion]], [[depression]],
| |
| | |
| Abnormal [[gait]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Complex or atypical [[migraine]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Family history of [[migraine]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Clinical assesment
| |
| |style="background: #F5F5F5; padding: 5px;" |Presence of aura, [[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Hypertensive encephalopathy]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |[[Hypertension]]
| |
| |style="background: #F5F5F5; padding: 5px;" | +
| |
| |style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Clinical assesment
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Delirium]], [[cortical blindness]], [[cerebral edema]], [[seizure]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Wernicke's encephalopathy|Wernicke’s encephalopathy]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of alcohal abuse
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and lab findings
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Ophthalmoplegia]], [[confusion]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brain abscess|CNS abscess]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of [[drug abuse]], [[endocarditis]], [[immunosupression]]
| |
| |style="background: #F5F5F5; padding: 5px;" | +
| |
| |style="background: #F5F5F5; padding: 5px;" |'''↑''' leukocytes, '''↓''' glucose and '''↑''' protien
| |
| |style="background: #F5F5F5; padding: 5px;" |MRI is more sensitive and specific
| |
| |style="background: #F5F5F5; padding: 5px;" |High grade [[fever]], [[fatigue]],[[nausea]], [[vomiting]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Drug toxicity]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Drug screen test
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Lithium]], [[Sedatives]], [[phenytoin]], [[carbamazepine]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Conversion disorder]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of [[emotional stress]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| |style="background: #F5F5F5; padding: 5px;" |Diagnosis of exclusion
| |
| |style="background: #F5F5F5; padding: 5px;" |[[Tremor|Tremors]], [[blindness]], difficulty [[swallowing]]
| |
| |-
| |
| |style="background: #DCDCDC; padding: 5px; text-align: center;" |Metabolic disturbances ([[electrolyte imbalance]], [[hypoglycemia]])
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Hypoglycemia]], [[Hyponatremia|hypo]] and [[hypernatremia]], [[Hypokalemia|hypo]] and [[hyperkalemia]]
| |
| |style="background: #F5F5F5; padding: 5px;" |Depends on the cause
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[seizure]], [[Palpitation|palpitations]], [[sweating]], [[dizziness]], [[hypoglycemia]]
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Multiple sclerosis]] exacerbation
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |History of relapses and remissions
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" | +
| |
| | style="background: #F5F5F5; padding: 5px; text-align:center" |'''↑''' CSF IgG levels
| |
| (monoclonal bands)
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[MRI]] <ref name="pmid8274111">{{cite journal| author=Giang DW, Grow VM, Mooney C, Mushlin AI, Goodman AD, Mattson DH et al.| title=Clinical diagnosis of multiple sclerosis. The impact of magnetic resonance imaging and ancillary testing. Rochester-Toronto Magnetic Resonance Study Group. | journal=Arch Neurol | year= 1994 | volume= 51 | issue= 1 | pages= 61-6 | pmid=8274111 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8274111 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Blurred vision|Blurry vision]], [[urinary incontinence]], [[fatigue]]
| |
| |-
| |
| | style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Seizure]]
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | -
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" | +
| |
| |style="background: #F5F5F5; padding: 5px text-align:center" |Previous history of [[seizures]]
| |
| | style="background: #F5F5F5; padding: 5px;" | -
| |
| | style="background: #F5F5F5; padding: 5px;" |Mass lesion
| |
| | style="background: #F5F5F5; padding: 5px;" |Clinical assesment and [[EEG]] <ref name="pmid11385043">{{cite journal| author=Manford M| title=Assessment and investigation of possible epileptic seizures. | journal=J Neurol Neurosurg Psychiatry | year= 2001 | volume= 70 Suppl 2 | issue= | pages= II3-8 | pmid=11385043 | doi= | pmc=1765557 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11385043 }}</ref>
| |
| | style="background: #F5F5F5; padding: 5px;" |[[Confusion]], [[apathy]], [[irritability]],
| |
| |}
| |
| | |
| ==Diagnosis==
| |
| Diagnosis of meningitis, is based on clinical presentation in combination with CSF analysis. CSF analysis has major role for diagnosis and rule out other possibilities. The following table summarizes the CSF findings in different types of meningitis.<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref><ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref><ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref><ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref><ref name="pmid20610819">{{cite journal| author=Brouwer MC, Tunkel AR, van de Beek D| title=Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. | journal=Clin Microbiol Rev | year= 2010 | volume= 23 | issue= 3 | pages= 467-92 | pmid=20610819 | doi=10.1128/CMR.00070-09 | pmc=2901656 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20610819 }} </ref>
| |
| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
| |
| |+
| |
| ! style="background: #4479BA; width: 150px;" | {{fontcolor|#FFF|Cerebrospinal fluid level}}
| |
| ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Normal level}}
| |
| ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Bacterial meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref>
| |
| ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Viral meningitis}}<ref name="pmid10654948">{{cite journal| author=Negrini B, Kelleher KJ, Wald ER| title=Cerebrospinal fluid findings in aseptic versus bacterial meningitis. | journal=Pediatrics | year= 2000 | volume= 105 | issue= 2 | pages= 316-9 | pmid=10654948 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10654948 }} </ref>
| |
| ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Fungal meningitis}}
| |
| ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Tuberculous meningitis}}<ref name="pmid20146981">{{cite journal| author=Caudie C, Tholance Y, Quadrio I, Peysson S| title=[Contribution of CSF analysis to diagnosis and follow-up of tuberculous meningitis]. | journal=Ann Biol Clin (Paris) | year= 2010 | volume= 68 | issue= 1 | pages= 107-11 | pmid=20146981 | doi=10.1684/abc.2010.0407 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20146981 }} </ref>
| |
| ! style="background: #4479BA; width: 350px;" | {{fontcolor|#FFF|Neoplastic meningitis}}<ref name="pmid23717798">{{cite journal| author=Le Rhun E, Taillibert S, Chamberlain MC| title=Carcinomatous meningitis: Leptomeningeal metastases in solid tumors. | journal=Surg Neurol Int | year= 2013 | volume= 4 | issue= Suppl 4 | pages= S265-88 | pmid=23717798 | doi=10.4103/2152-7806.111304 | pmc=3656567 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23717798 }} </ref>
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" | '''Cells/ul'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''< 5'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''>300'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''10-1000'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''10-500'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''50-500'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''>4'''
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |'''Cells'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Leukocyte]] > [[Lymphocyte]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Lymphocyte]] > [[Leukocyte]]'''
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |'''Total protein (mg/dl''')
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''45-60'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-500'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" | '''Normal or slightly high'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''High'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''Typically 100-200'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''>50'''
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |'''Glucose ratio (CSF/plasma)<ref name="pmid24326618">{{cite journal| author=Chow E, Troy SB| title=The differential diagnosis of hypoglycorrhachia in adult patients. | journal=Am J Med Sci | year= 2014 | volume= 348 | issue= 3 | pages= 186-90 | pmid=24326618 | doi=10.1097/MAJ.0000000000000217 | pmc=4065645 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24326618 }} </ref>'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.5'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.3'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''> 0.6'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''<0.3'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''< 0.5'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''<0.5'''
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |'''Lactate (mmols/l)<ref name="pmid22880096">{{cite journal| author=Leen WG, Willemsen MA, Wevers RA, Verbeek MM| title=Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. | journal=PLoS One | year= 2012 | volume= 7 | issue= 8 | pages= e42745 | pmid=22880096 | doi=10.1371/journal.pone.0042745 | pmc=3412827 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22880096 }} </ref>'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''< 2.1'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''>3.2'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''> 2.1'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''>2.1'''
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC;" |'''Others'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[Intracranial pressure|Intra-cranial pressure]] (ICP) = 6-12 (cm H2O)'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF culture, CSF bacterial antigen'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of HSV-DNA, VZV'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF [[gram stain]], CSF india ink'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''[[PCR]] of TB-DNA'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |'''CSF tumour markers such as [[Alpha-fetoprotein|alpha fetoprotein]], [[CEA]]'''
| |
| |-
| |
| |}
| |
| | |
| ==References==
| |
| {{reflist|2}}
| |
