Non-infectious: Collagen vascular disease→ lupus, cancer involving the meninges, post infectious, medications→ NSAIDs, IVIG, other
Risk Factors
Strep: living in close quarters (college dorms, barracks), asplenic, immunocompromised, not vaccinated
Neisseria: Living in close quarters (college dorms, barracks), not vaccinated
H Flu: not-vaccinated
Listeria: ends of the age spectrum (old or young)
Measels: not vaccinated
Fungal, Mycobacterial: HIV, compromised by chemotherapy or meds that impair T-Cell function
Parasites: exposure in an endemic area, not-using prophylaxis (malaria), eating contaminated pork (T Solium)
Symptoms
Photphobia
Headache
Fever
Acute neck stiffness
Spectrum from acute confusion to obtundation
Generalized illness
Fungal, mycobacteriall tend to cause more sub-acute sx
Physical Exam Findings
F
Neck pain w/paracervical palpation; sometimes wont bend neck--> can raise torso off bed
+ Kernigs (specific not sensitive)→ pain with passive knee extension when hip flexed to 90; + Brudzinski (specific not sensitive)→ hip and knee flexion occurs w/passive neck flexion
+ jolt (sensitive not specific)→ worsening ha when patient rotates head back & forth
Less common to have focal neurological findings and overall less impaired compared w/encephalitis
Typical CSF Findings (Viral): Normal or mildly elevated opening pressure , WBC 25-500 (lymph predominance), normal glucose, protein 20-80, gram stain -
Typical CSF Findings (Fungal): Normal to elevated opening pressure , WBC elevated (lymph predominance), normal glucose, protein normal to high, gram stain -