1. Viral Meningitis Dr. Nagula Praveen

2. Frontal or retrorbital headache Photphobia Pain on moving the eyes Terminal neck rigidity Profound alterations in consciousness –think of viral encephalitis Seizures,focal neurological disturbances --unsual

3. ETIOLOGY Can be known by CSF analysis,CSFPCR,culture,serology Most imp ..ENTERO viruses,HSV -2 ,arboviruses. 2/3 CSF culture negative are positive by CSF PCR.

5. CSF analysis Lymphocytic pleocytosis 25-500 cells/ul Thousands LCMV Normal or raised proteins Normal glucose Normal or mild elevated CSF pressure Decreased glucose –think of Mumps,LCMV. PMNs dominate – echovirus 9,EEE,mumps For 1 week –WNV CSF oligoclonal bands –viral,multiplesclerosis,neuorsyphilis,borreliosis

6. Differential diagnosis Partially treated bacterial meningitis Early fungal,tuberculosis Mycoplasma,listeria noeplastic

7. ENTERO VIRUS Most common >75% cases CSF RT PCR – diagnosis Summer months Rx is supportive Stigmata of enterovirus -herpangina,plurodynia,myopericarditis,hemorrhagic conjunctivitis.

8. ARBO viruses Cluster of cases

9. others HSV 2 More in women Second MC in adults Most common cause of recurrent meningitis VZV – concurrent chicken pox,shingles EBV –cannot be cultured from CSF Mumps – lifelong immunity once episode treated

10. Treatment Supportive Analegiscs Antipyretics Antiemetics Fluid balance Oral/IV acylcovir –HSV,VZV,EBV 15-30mg/kg/day in 3 divided doses. PLECORANIL FULL RECOVERY IS THE RULE USUALLY

11. LEPTOMENINGEALMETASTASES CARCINOMATOUS MENINGITIS

12. CARCINOMA BREAST,lymphoma,leukemia Infiltration of cranial,spinalnerves,direct invasion of brain,spinalcord,obstructive hydrocephalus --- multiple neuro defects Cytology may show malignant cells Spinal tap should be done twice before saying negative CT scan –contrast enhancement in basal cisterns,showinghydorcephalus without mass lesion Myelography –deposits over multiple nerve roots Rx – irradiation,intrathecalmethotrexate. Poor prognosis – 10 % surivival for 1 yr

13. Mollaret meningitis

14. Mollaret's meningitis is a recurrent inflammation of the protective membranes covering thebrain and spinal cord, known collectively as the meninges. It is a recurrent, benign, aseptic meningitis. Recurrent episodes of severe headache, 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. Although historically Mollaret's meningitis did not have a causative agent, it is now believed to be mostly from herpetic infection. CNS epidermoid cysts can give rise to Mollaret's meningitis especially with surgical manipulation of cyst contents.

15. Chronic meningtis With no improvement over a period of 4 weeks Nonifectious infectious

16. TO BE COMPLETED……. CEREBRAL MALARIA BRAIN ABSCESS NEUROTUBERCULOSIS NUEROCYSTICERCOSIS SSPE BENIGN INTRACRANIAL HYPERTENSION HYDROCEPHALUS PSEUDOTUMOR CEREBRI ASTROCYTOMA CORTICAL VENOUS THROMBOSIS

17. To be completed 1.CEREBRAL MALARIA 2.SSPE 3.HYDROCEPHALUS 4.CSF circulation 5.benign intracranial hypertension 6.pseudotumor cerebri 7.neurocysticercosis 8.neurotuberculosis 9.brain abscess 10.cortical sinus venous thrombosis THANK YOU THANK YOU