Meningitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Differentiating Meningitis from other Diseases

• Brain abscess - Brain abcess is a focal infection of the brain parenchyma commonly caused by bacteria, fungal and parasitic pathogens. Imaging and neurosurgical aspiration is required for is differentiation in addition to CSF profile.

• Encephalitis - Encephatlitis is the inflammation of brain. Meningitis can itself cause encephalitis and is called meningoencephalitis. The symptoms appear gradually in encephalitis but occur abruptly in meningitis.

• Delirium tremens - Delirium tremens and alcohol withdrawal should be differentiated from meningitis especially when present with confusion and fever. Both the conditions can coexist.

• Brain tumor - Brain tumours can simulate purulent meningitis with symptoms of fever, signs of meningeal irritation and marked CSF pleocytosis. Irritation of leptomeninges by tumor and its breakdown products causes these symptoms. Determination of creatine kinase BB and carcinoembryonic antigenhelps in differentiating.

• Subarachnoid hemorrhage - Subarachnoid hemorrhage also presents with severe headache, neck stiffness, nausea and vomiting like meningitis. It is a medical emergency. Imaging studies help in differentiating. Tubercular meningitis should ]be considered in the differential diagnosis in cases of nonaneurysmal subarachnoid hemorrhage.