Mollaret's meningitis: Difference between revisions
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==Diagnosis== | ==Diagnosis== | ||
===History and Symptoms=== | ===History and Symptoms=== | ||
Mollaret's meningitis is characterized by recurrent episodes of severe headache, [[meningismus]], and [[fever]]. | Mollaret's meningitis is characterized by recurrent episodes of severe [[headache]], [[meningismus]], and [[fever]]. | ||
===Laboratory Findings=== | ===Laboratory Findings=== | ||
Investigations include [[blood test]]s (electrolytes, liver and kidney function, inflammatory markers and a [[complete blood count]]) and usually [[X-ray]] examination of the chest. The most important test in identifying or ruling out meningitis is analysis of the [[cerebrospinal fluid]] (fluid that envelops the brain and the spinal cord) through [[lumbar puncture]] (LP). However, if the patient is at risk for a cerebral mass lesion or elevated [[intracranial pressure]] (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a lumbar puncture may be contraindicated because of the possibility of fatal [[brain herniation]]. [[Cerebrospinal fluid]] (CSF) [[pleocytosis]] with large "endothelial" cells, [[neutrophils]], and [[lymphocyte]]s; and attacks separated by symptom-free periods of weeks to months; and spontaneous remission of symptoms and signs. <ref>Mollaret's meningitis at patient.co.uk</ref> | Investigations include [[blood test]]s ([[Electrolyte|electrolytes]], [[liver]] and [[kidney]] function, [[Inflammatory|inflammatory markers]] and a [[complete blood count]]) and usually [[X-ray]] examination of the chest. The most important test in identifying or ruling out meningitis is analysis of the [[cerebrospinal fluid]] (fluid that envelops the brain and the spinal cord) through [[lumbar puncture]] (LP). However, if the patient is at risk for a cerebral mass lesion or elevated [[intracranial pressure]] (recent [[head injury]], a known immune system problem, localizing neurological signs, or evidence on examination of a [[ICP|raised ICP]]), a [[lumbar puncture]] may be contraindicated because of the possibility of fatal [[brain herniation]]. [[Cerebrospinal fluid]] (CSF) [[pleocytosis]] with large "endothelial" cells, [[neutrophils]], and [[lymphocyte]]s; and attacks separated by symptom-free periods of weeks to months; and spontaneous remission of symptoms and signs.<ref>Mollaret's meningitis at patient.co.uk</ref> | ||
===CT/MRI=== | ===CT/MRI=== | ||
In such cases a [[Computed tomography|CT]] or [[Magnetic resonance imaging|MRI]] scan is generally performed prior to the lumbar puncture to exclude this possibility. Otherwise, the CT or MRI should be performed after the LP, with MRI preferred over CT due to its superiority in demonstrating areas of cerebral edema, ischemia, and meningeal inflammation. During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H<sub>2</sub>O is indicative of bacterial meningitis. Mollaret's meningitis is suspected based on clinical criteria and confirmed by HSV 1 or HSV 2 on PCR of CSF. | In such cases a [[Computed tomography|CT]] or [[Magnetic resonance imaging|MRI]] scan is generally performed prior to the [[lumbar puncture]] to exclude this possibility. Otherwise, the CT or MRI should be performed after the LP, with MRI preferred over CT due to its superiority in demonstrating areas of [[cerebral edema]], [[ischemia]], and meningeal [[inflammation]]. During the [[lumbar puncture]] procedure, the opening pressure is measured. A pressure of over 180 mm H<sub>2</sub>O is indicative of bacterial meningitis. Mollaret's meningitis is suspected based on clinical criteria and confirmed by [[HSV-1|HSV 1]] or [[HSV-2|HSV 2]] on [[PCR]] of [[CSF]]. | ||
==Treatment== | ==Treatment== | ||
Revision as of 16:34, 31 May 2017
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Mollaret's meningitis On the Web |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Synonyms and keywords: Benign recurrent meningitis; Mollaret disease; benign multirecurrent endothelioleucocytal meningitis
Overview
Mollaret's meningitis is a recurrent inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Mollaret's meningitis is caused by herpes simplex virus. It is a recurrent, benign, aseptic meningitis.
Historical Perspectve
It is named for Pierre Mollaret.[1][2]
Diagnosis
History and Symptoms
Mollaret's meningitis is characterized by recurrent episodes of severe headache, meningismus, and fever.
Laboratory Findings
Investigations include blood tests (electrolytes, liver and kidney function, inflammatory markers and a complete blood count) and usually X-ray examination of the chest. The most important test in identifying or ruling out meningitis is analysis of the cerebrospinal fluid (fluid that envelops the brain and the spinal cord) through lumbar puncture (LP). However, if the patient is at risk for a cerebral mass lesion or elevated intracranial pressure (recent head injury, a known immune system problem, localizing neurological signs, or evidence on examination of a raised ICP), a lumbar puncture may be contraindicated because of the possibility of fatal brain herniation. 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.[3]
CT/MRI
In such cases a CT or MRI scan is generally performed prior to the lumbar puncture to exclude this possibility. Otherwise, the CT or MRI should be performed after the LP, with MRI preferred over CT due to its superiority in demonstrating areas of cerebral edema, ischemia, and meningeal inflammation. During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H2O is indicative of bacterial meningitis. Mollaret's meningitis is suspected based on clinical criteria and confirmed by HSV 1 or HSV 2 on PCR of CSF.
Treatment
Medical Therapy
Acyclovir is the treatment of choice for Mollaret's meningitis.
Related Chapters
References
- ↑ Template:WhoNamedIt
- ↑ P. Mollaret. Méningite endothélio-leucocytaire multirécurrente bénigne. Syndrome nouveau ou maladie nouvelle? (Documents cliniques). Revue neurologique, Paris, 1944, 76: 57-76.
- ↑ Mollaret's meningitis at patient.co.uk
Template:Viral diseases Template:Diseases of the nervous system