Mollaret's meningitis
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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
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