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PloS One 2017We undertook a systematic review and meta-analysis to address the question "what is the impact of meningitis on IQ and development." (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
We undertook a systematic review and meta-analysis to address the question "what is the impact of meningitis on IQ and development."
METHODS
Search: conducted using standardized search terms across Medline, PsychInfo and EMBASE to 06/2014. Eligibility: human studies of any infectious aetiology of meningitis reporting IQ or infant developmental age or stage outcomes. Quality: Centre for Evidence Based Medicine, Oxford, quality tools. Analysis: random effects meta-analysis by organism.
RESULTS
39 studies were included in the review, 34 providing data on IQ (2015 subjects) and 12 on developmental delay (382 subjects). Across all bacterial organisms, meningitis survivors had a mean IQ 5.50 (95% CI: -7.19, -3.80; I2 = 47%, p = 0.02) points lower than controls. IQ was significantly lower than controls for Neisseria meningitides (NM: 5 points) and Haemophilus influenzae b (Hib: 6 points) but not in viral meningitis, with only single studies included for Streptococcus pneumoniae (SP) and group B streptococcus (GBS). The pooled relative risk (RR) for low IQ (IQ<70) in survivors of bacterial meningitis compared with controls was 4.99 (95% CI: 3.17, 7.86) with no significant heterogeneity (I2 = 49%, p = 0.07). Developmental delay of approximately 0.5SD was reported in studies of bacterial meningitis but no delay in the only study of viral meningitis.
CONCLUSIONS
We found moderate evidence that surviving bacterial meningitis has a deleterious impact on IQ and development but no evidence that viral meningitis had meaningful cognitive impacts. Survivors of bacterial meningitis should be routinely offered screening for cognitive deficits and developmental delay in addition to hearing loss.
Topics: Humans; Intelligence; Meningitis, Bacterial; Meningitis, Viral
PubMed: 28837564
DOI: 10.1371/journal.pone.0175024 -
European Journal of Immunology Sep 2023In the past 10 years, important discoveries have been made in the field of neuroimmunology, especially regarding brain borders. Indeed, meninges are protective envelopes... (Review)
Review
In the past 10 years, important discoveries have been made in the field of neuroimmunology, especially regarding brain borders. Indeed, meninges are protective envelopes surrounding the CNS and are currently in the spotlight, with multiple studies showing their involvement in brain infection and cognitive disorders. In this review, we describe the meningeal layers and their protective role in the CNS against bacterial, viral, fungal, and parasitic infections, by immune and nonimmune cells. Moreover, we discuss the neurological and cognitive consequences resulting from meningeal infections in neonates (e.g. infection with group B Streptococcus, cytomegalovirus, …) or adults (e.g. infection with Trypanosoma brucei, Streptococcus pneumoniae, …). We hope that this review will bring to light an integrated view of meningeal immune regulations during CNS infections and their neurological consequences.
Topics: Adult; Infant, Newborn; Humans; Meninges; Brain; Central Nervous System Infections; Streptococcus pneumoniae
PubMed: 37402972
DOI: 10.1002/eji.202250267 -
Current Opinion in Neurobiology Jun 2020In the past five years, the surrounding of the brain, that is the meninges (singular meninx) have evolved from being a physical barrier that protects the brain... (Review)
Review
In the past five years, the surrounding of the brain, that is the meninges (singular meninx) have evolved from being a physical barrier that protects the brain parenchyma to becoming a central player for both the maintenance of normal brain function and the modulation of neurological disorders. Indeed, the meninges are an immunologically active compartment that communicates with the periphery via the (re)discovered meningeal lymphatic system. From its ties to both the periphery and the central nervous system, the meninges are becoming a prevalent organ to understand and modulate brain homeostasis. Here we will focus on current advances in our understanding of the meningeal compartment with an emphasis on the meningeal lymphatic network as a key regulator.
Topics: Brain; Central Nervous System; Lymphatic System; Lymphatic Vessels; Meninges
PubMed: 31816570
DOI: 10.1016/j.conb.2019.11.010 -
Journal of Neuroinflammation May 2023The meninges, membranes surrounding the central nervous system (CNS) boundary, harbor a diverse array of immunocompetent immune cells, and therefore, serve as an... (Review)
Review
The meninges, membranes surrounding the central nervous system (CNS) boundary, harbor a diverse array of immunocompetent immune cells, and therefore, serve as an immunologically active site. Meningeal immunity has emerged as a key factor in modulating proper brain function and social behavior, performing constant immune surveillance of the CNS, and participating in several neurological diseases. However, it remains to be determined how meningeal immunity contributes to CNS physiology and pathophysiology. With the advances in single-cell omics, new approaches, such as single-cell technologies, unveiled the details of cellular and molecular mechanisms underlying meningeal immunity in CNS homeostasis and dysfunction. These new findings contradict some previous dogmas and shed new light on new possible therapeutic targets. In this review, we focus on the complicated multi-components, powerful meningeal immunosurveillance capability, and its crucial involvement in physiological and neuropathological conditions, as recently revealed by single-cell technologies.
Topics: Humans; Meninges; Central Nervous System; Nervous System Diseases
PubMed: 37231449
DOI: 10.1186/s12974-023-02803-z -
Nature Neuroscience Jul 2022The meninges, comprising the leptomeninges (pia and arachnoid layers) and the pachymeninx (dura layer), participate in central nervous system (CNS) autoimmunity, but...
The meninges, comprising the leptomeninges (pia and arachnoid layers) and the pachymeninx (dura layer), participate in central nervous system (CNS) autoimmunity, but their relative contributions remain unclear. Here we report on findings in animal models of CNS autoimmunity and in patients with multiple sclerosis, where, in acute and chronic disease, the leptomeninges were highly inflamed and showed structural changes, while the dura mater was only marginally affected. Although dural vessels were leakier than leptomeningeal vessels, effector T cells adhered more weakly to the dural endothelium. Furthermore, local antigen-presenting cells presented myelin and neuronal autoantigens less efficiently, and the activation of autoreactive T cells was lower in dural than leptomeningeal layers, preventing local inflammatory processes. Direct antigen application was required to evoke a local inflammatory response in the dura. Together, our data demonstrate an uneven involvement of the meningeal layers in CNS autoimmunity, in which effector T cell trafficking and activation are functionally confined to the leptomeninges, while the dura remains largely excluded from CNS autoimmune processes.
Topics: Animals; Arachnoid; Autoimmunity; Central Nervous System; Dura Mater; Humans; Meninges; Multiple Sclerosis
PubMed: 35773544
DOI: 10.1038/s41593-022-01108-3 -
Fundamental & Clinical Pharmacology Jun 2018Aseptic meningitis associates a typical clinical picture of meningitis with the absence of bacterial or fungal material in the cerebrospinal fluid. Drug-induced aseptic... (Review)
Review
Aseptic meningitis associates a typical clinical picture of meningitis with the absence of bacterial or fungal material in the cerebrospinal fluid. Drug-induced aseptic meningitis (DIAM) may be due to two mechanisms: (i) a direct meningeal irritation caused by the intrathecal administration of drugs and (ii) an immunologic hypersensitivity reaction to a systemic administration. If the direct meningeal irritation allows a rather easy recognition, the immunologic hypersensitivity reaction is a source of challenging diagnostics. DIAM linked to a systemic treatment exerts typically an early onset, usually within a week. This period can be shortened to a few hours in case of drug rechallenge. The fast and spontaneous regression of clinical symptoms is usual after stopping the suspected drug. Apart from these chronological aspects, no specific clinical or biological parameters are pathognomonic. CSF analysis usually shows pleiocytosis. The proteinorachia is increased while glycorachia remains normal. Underlying pathologies can stimulate the occurrence of DIAM. Thus, systemic lupus erythematosus appears to promote DIAM during NSAID therapy, especially ibuprofen-based one. Similarly, some patients with chronic migraine are prone to intravenous immunoglobulin-induced aseptic meningitis. DIAM will be mainly evoked on chronological criteria such as rapid occurrence after initiation, rapid regression after discontinuation, and recurrence after rechallenge of the suspected drug. When occurring, positive rechallenge may be very useful in the absence of initial diagnosis. Finally, DIAM remains a diagnosis of elimination. It should be suggested only after all infectious causes have been ruled out.
Topics: Animals; Humans; Meningitis, Aseptic; Predictive Value of Tests; Prognosis; Risk Factors
PubMed: 29364542
DOI: 10.1111/fcp.12349 -
Immune-Mediated Hypertrophic Pachymeningitis and its Mimickers: Magnetic Resonance Imaging Findings.Academic Radiology Nov 2023Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an... (Review)
Review
Hypertrophic pachymeningitis (HP) is a rare and chronic inflammatory disorder presenting as localized or diffuse thickening of the dura mater. It can be idiopathic or an unusual manifestation of immune-mediated, infectious, and neoplastic conditions. Although some cases may remain asymptomatic, HP can lead to progressive headaches, cranial nerve palsies, hydrocephalus, and other neurological complications, which makes its recognition a fundamental step for prompt treatment. Regarding the diagnosis workup, enhanced MRI is the most useful imaging method to evaluate dural thickening. This article addresses the MR imaging patterns of immune-mediated HP, including immunoglobulin G4-related disease, neurosarcoidosis, granulomatosis with polyangiitis, rheumatoid pachymeningitis, and idiopathic HP. The main infectious and neoplastic mimicking entities are also discussed with reference to conventional and advanced MR sequences.
Topics: Humans; Diagnosis, Differential; Dura Mater; Hypertrophy; Magnetic Resonance Imaging; Meningitis
PubMed: 36882352
DOI: 10.1016/j.acra.2023.01.017 -
Neuroimaging Clinics of North America Feb 2023Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic... (Review)
Review
Neuroimaging provides rapid, noninvasive visualization of central nervous system infections for optimal diagnosis and management. Generalizable and characteristic imaging patterns help radiologists distinguish different types of intracranial infections including meningitis and cerebritis from a variety of bacterial, viral, fungal, and/or parasitic causes. Here, we describe key radiologic patterns of meningeal enhancement and diffusion restriction through profiles of meningitis, cerebritis, abscess, and ventriculitis. We discuss various imaging modalities and recent diagnostic advances such as deep learning through a survey of intracranial pathogens and their radiographic findings. Moreover, we explore critical complications and differential diagnoses of intracranial infections.
Topics: Humans; Neuroimaging; Meningitis; Diagnosis, Differential
PubMed: 36404039
DOI: 10.1016/j.nic.2022.07.001 -
The Pediatric Infectious Disease Journal Jul 2016During the past several decades, researchers have shown that the eponymous signs of meningitis have reduced sensitivity and specificity compared with when they were... (Review)
Review
During the past several decades, researchers have shown that the eponymous signs of meningitis have reduced sensitivity and specificity compared with when they were originally described. This may be because of the changing epidemiology of meningitis and its treatment or it may be because of variations in performance of the maneuvers. For example, in the original descriptions, the Kernig sign (resistance of leg extension) is best elicited with the patient sitting and the Brudzinski nape of the neck sign involves holding down the patient's chest as the neck is flexed. These and other lesser-known signs of meningitis by Amoss, Bikeles and Edelmann all relate to the mechanics of stretching inflamed meninges, and this review will allow the clinician to understand how the history related to these maneuvers is still germane to clinical practice today.
Topics: Diagnosis, Differential; History, 19th Century; History, 20th Century; History, 21st Century; Humans; Meningitis; Neurologic Examination; Physical Examination; Reflex, Abnormal; Sensitivity and Specificity
PubMed: 27031257
DOI: 10.1097/INF.0000000000001152 -
Current Opinion in Hematology May 2022The recent (re)discovery of the meningeal lymphatic has brought a new player in brain neurophysiology. This review highlights the state of the current research on the... (Review)
Review
PURPOSE OF REVIEW
The recent (re)discovery of the meningeal lymphatic has brought a new player in brain neurophysiology. This review highlights the state of the current research on the meningeal lymphatic vasculature, from its specific physiology to its increasing implication in normal and pathological brain function.
RECENT FINDINGS
Growing evidence are emerging about the uniqueness of the meningeal lymphatic vasculature and its implication in multiple neurological and neurotraumatic disorders.
SUMMARY
These studies are highlighting a new and unexpected role for the lymphatic vasculature in brain function and a potential new therapeutic target for neurological disorders.
Topics: Brain; Humans; Lymphatic System; Lymphatic Vessels; Meninges
PubMed: 35441600
DOI: 10.1097/MOH.0000000000000711