Mollaret's meningitis: Difference between revisions
→Diagnosis: Added info from Sunden et al |
|||
| Line 32: | Line 32: | ||
|title= Directional Spread of Alphaherpesviruses in the Nervous System |
|title= Directional Spread of Alphaherpesviruses in the Nervous System |
||
|journal= Viruses |volume=5 |issue= |pages=678-707 |date=2013 |pmid=|doi=10.3390/v5020678}}</ref>. |
|journal= Viruses |volume=5 |issue= |pages=678-707 |date=2013 |pmid=|doi=10.3390/v5020678}}</ref>. |
||
A study performed on patients who had diffuse symptoms, such as persistent or intermittent headaches, concluded that although PCR is a highly sensitive method for detection, it may not always be sensitive enough for identification of viral DNA in CSF, due to the fact that viral shedding from latent infection may be very low. The concentration of viruses in CSF during subclinical infection might be very low<ref >{{cite journal |author= Birgitta Sundén, Marie Larsson, Tina Falkeborn, Jakob Paues, Urban Forsum, Magnus Lindh, Liselotte Ydrenius, Britt Åkerlind and Lena Serrander |
|||
|title= Real-time PCR detection of Human Herpesvirus 1-5 in patients lacking clinical signs of a viral CNS infection|journal= BMC Infectious Diseases |
|||
|volume=11|issue=220|pages=|date=2011 |pmid= 21849074|doi=|url=http://www.biomedcentral.com/1471-2334/11/220}}</ref>. |
|||
Revision as of 01:53, 15 September 2014
| Mollaret's meningitis | |
|---|---|
| Specialty | Infectious diseases  |
Mollaret's meningitis is a recurrent inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Since Mollaret meningitis is a recurrent, benign, aseptic meningitis, it is now referred to as "Benign Recurrent Lymphocytic Meningitis".[1]
It was named for Pierre Mollaret, the French neurologist who first described it in 1944.[2][3][4]
Signs and symptoms
Mollaret's meningitis is characterized by recurrent episodes of headache, stiff neck, meningismus, and fever; 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. Many people have side effects between bouts that vary from chronic daily headaches to after-effects from meningitis such as hearing loss. Some patients report short bouts of 3–7 days of being sick while others have cases that can last for weeks or months. Many references talk about brief acute cases but support groups of people with Mollaret's show a wide variety of lengths of each bout.
Cause
Although for a long time, the causative agent of Mollaret's meningitis was not known, recent work has associated this problem with herpetic infection.[5] A case of Mollaret's resulting from Varicella zoster virus infection, diagnosed by PCR, has also been documented. In this case, PCR for herpes simplex was negative.[6] Some patients also report frequent shingles outbreaks.[citation needed] The chickenpox virus is part of the herpes family.[7] CNS epidermoid cysts can give rise to Mollaret's meningitis especially with surgical manipulation of cyst contents.
A familial association, where more than one family member had Mollaret's, has been documented. [8]
Diagnosis
Mollaret's meningitis is suspected based on symptoms, and confirmed by HSV 1 or HSV 2 on PCR of CSF, although not all cases test positive on PCR. PCR is performed on spinal fluid or blood, however, the viruses do not need to enter the spinal fluid or blood to spread within the body: they can spread by moving through the axons and dendrites of the nerves[9].
A study performed on patients who had diffuse symptoms, such as persistent or intermittent headaches, concluded that although PCR is a highly sensitive method for detection, it may not always be sensitive enough for identification of viral DNA in CSF, due to the fact that viral shedding from latent infection may be very low. The concentration of viruses in CSF during subclinical infection might be very low[10].
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. 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 suggestive of bacterial meningitis.
It is likely that Mollaret meningitis is underrecognized by physicians, and improved recognition may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission.[8]
Treatment
Initial treatment
Acyclovir is the treatment of choice for Mollaret's meningitis. Some patients see a drastic difference in how often they get sick and others don't. Often treatment means managing symptoms, such as pain management and strengthening the immune system.
See also
References
- ^ Shalabi M, Whitley RJ. Recurrent benign lymphocytic meningitis. Clin Infect Dis. 2006;43(9):1194-1197. PMID 17029141
- ^ synd/1537 at Who Named It?
- ^ P. Mollaret. Méningite endothélio-leucocytaire multirécurrente bénigne. Syndrome nouveau ou maladie nouvelle? (Documents cliniques). Revue neurologique, Paris, 1944, 76: 57-76.
- ^ La méningite endothélio-leukocytaire multi-récurrente bénigne. Rev Neurol (Paris) 1944;76:57-67.
- ^ Tarakad S Ramachandran, MBBS, FRCP(C), FACP (Feb 12, 2010). "Aseptic Meningitis". Emedicine. Retrieved 9 January 2011.
{{cite web}}: CS1 maint: multiple names: authors list (link) - ^ Ohmichi, T., Takezawa, H., Fujii, C., Tomii, Y., Yoshida, T., & Nakagawa, M. (2012). "Mollaret cells detected in a patient with varicella-zoster virus meningitis". Clinical Neurology and Neurosurgery,. 114 (7): 1086–7. PMID 22402203.
{{cite journal}}: CS1 maint: extra punctuation (link) CS1 maint: multiple names: authors list (link) - ^ Mollaret's meningitis at patient.co.uk
- ^ a b Jones CW, Snyder GE (2011). "Mollaret meningitis: case report with a familial association". Am J Emerg Med.,. 29 (7). doi:10.1016/j.ajem.2010.02.008. PMID 20825883.
{{cite journal}}: CS1 maint: extra punctuation (link) - ^ Tal Kramer, Lynn W. Enquist (2013). "Directional Spread of Alphaherpesviruses in the Nervous System". Viruses. 5: 678–707. doi:10.3390/v5020678.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Birgitta Sundén, Marie Larsson, Tina Falkeborn, Jakob Paues, Urban Forsum, Magnus Lindh, Liselotte Ydrenius, Britt Åkerlind and Lena Serrander (2011). "Real-time PCR detection of Human Herpesvirus 1-5 in patients lacking clinical signs of a viral CNS infection". BMC Infectious Diseases. 11 (220). PMID 21849074.
{{cite journal}}: CS1 maint: multiple names: authors list (link)