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Global Health, Epidemiology and Genomics 2022The Global Burden of Disease Study in 2016 estimated that the global incident cases of meningitis have increased by 320,000 between 1990 and 2016. Current evidence... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The Global Burden of Disease Study in 2016 estimated that the global incident cases of meningitis have increased by 320,000 between 1990 and 2016. Current evidence suggests that diabetes may be a prime risk factor for meningitis among individuals, including older adults. However, findings of prior studies on this topic remain inconsistent, making a general conclusion relatively difficult. This study aimed to quantitatively synthesize the literature on the risk of meningitis associated with diabetes and compare the risk across different global regions.
METHOD
Literature search and study design protocol followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The search was conducted in PubMed, Web of Science, African Journal Online, and Google Scholar using relevant MESH terms. A random effect model was used to pull effect sizes.
RESULTS
Initial search yielded 772 papers but 756 studies were excluded due to duplicity and not meeting inclusion criteria. In all, 16 papers involving 16847 cases were used. The pulled effect size (ES) of the association between diabetes and meningitis was 2.240 (OR = 2.240, 95% CI = 1.716-2.924). Regional-base analysis showed that diabetes increased the risk of developing meningitis in Europe (OR = 1.737, 95% CI = 1.299-2.323), Asia (OR = 2.192, 95% CI = 1.233-3.898), and North America (OR = 2.819, 95% CI = 1.159-6.855). These associations remained significant in the study design and etiological classe-based subgroup analyses. However, we surprisingly found no studies in Africa or South America.
CONCLUSION
Diabetes is a risk factor for developing meningitis. Given that no research on this topic came from Africa and South America, our findings should be contextually interpreted. We, however, encourage studies on diabetes-meningitis linkages from all parts of the world, particularly in Africa and South America, to confirm the findings of the present study.
Topics: Humans; Aged; Diabetes Mellitus; Risk Factors; Africa; Meningitis; Asia
PubMed: 36570413
DOI: 10.1155/2022/3996711 -
Neurological Research Oct 2023To evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for the diagnosis of central nervous system infections (CNSI).
BACKGROUND
To evaluate the clinical utility of metagenomic next-generation sequencing (mNGS) for the diagnosis of central nervous system infections (CNSI).
METHODS
Cerebrospinal fluid (CSF) from 54 patients who were high-level clinical suspicion of CNSI was collected and sent for mNGS and conventional tests from January 2019 to March 2022.
RESULTS
Twenty out of 54 patients were diagnosed with CNSI and 34 non-CNSI. Among the 34 non-CNSI, one was false positive by mNGS. Among the 20 CNSI, 11 had presumed viral encephalitis and/or meningitis, 5 had presumed bacterial meningitis, 2 had presumed TMB, 1 had Crytococcus meningitis and 1 had neurosyphilis. The sensitivity of viral encephalitis and/or meningitis was 0.73 (8/11); 10 virus were detected; 9/10 was dsDNA; 1/10 was ssRNA. SSRN ranged from 1 to 13. The accuracy rate was 0.4, the accuracy rate was positively correlated with SSRN ( = 0.738, = 0.015), SSRN ≥ 1, the accuracy rate was 0.4; SSRN ≥ 3, the accuracy rate was 0.66; SSRN ≥ 4, the accuracy rate was 0.75; SSRN ≥ 6, the accuracy rate was 1. The sensitivity of bacterial meningitis was 1. Seven kinds of bacteria were detected, among which 3/7 were gram positive, 3/7 were gram negative, and 1/7 was infected NTM (nontuberculous mycobacteria). The accuracy rate was 0.43 (3/7). The sensitivity of TBM was 0.66 (2/3), the accuracy rate was 1. The sensitivity of Crytococcus meningitis was 1, the accuracy rate was 0.5. PPV (positive predictive value) of mNGS was 0.94, NPV (negative predictive value) of mNGS was 0.89, specificity was 0.97 and sensitivity was 0.8. The AUG for CSF mNGS diagnosis of CNSI was 0.89 (95% CI = 0.78-0.99) Headache, meningeal irritation sign and image of meninges abnormal were correlated with the sensitivity of mNGS ( = 0.451, 0.313, 0.446; = 0.001, 0.021, 0.001); CSF Glucose and CSF Chloride were negatively correlated with sensitivity of mNGS ( = -0.395, -0.462; = 0.003, < 0.001).
CONCLUSION
mNGS is a detection means with high sensitivity, wide coverage and strong timeliness, which can help clinicians to identify the pathogen diagnosis quickly, conduct targeted anti-infection treatment early and reduce antibiotic abuse. The pathogen which causing low CSF Glucose, low CSF Chloride or meninges infections was more likely to be detected by mNGS. It may be related to growth and structural characteristics of the pathogen and blood-brain barrier damage.
Topics: Humans; Chlorides; High-Throughput Nucleotide Sequencing; Meninges; Central Nervous System Infections; Encephalitis, Viral; Glucose; Communicable Diseases
PubMed: 37615407
DOI: 10.1080/01616412.2023.2247299 -
Modern Rheumatology Case Reports Jun 2023Rheumatoid arthritis (RA) is an autoimmune disease involving synovial joints, and it is known that extra-articular manifestations that may affect the central and... (Review)
Review
Rheumatoid arthritis (RA) is an autoimmune disease involving synovial joints, and it is known that extra-articular manifestations that may affect the central and peripheral nervous systems may develop during its course. Rheumatoid meningitis is very rare among all neurological involvements. In this study, cases diagnosed as rheumatoid meningitis with clinical, imaging, laboratory, and histopathological features are presented, and the aim of the study is to present current approaches in the diagnosis and treatment of rheumatoid meningitis in the light of case studies and current literature. The data of the patients who were followed up with the diagnosis of rheumatoid meningitis in neurology clinic between 2017 and 2021 were reviewed retrospectively. Three cases diagnosed with rheumatoid meningitis are presented in detail. In the first case, the diagnosis was reached by clinical, imaging, and laboratory findings as well as treatment response, while the diagnosis was made by histopathological verification in the second case. The third case shows that spontaneous remission can be observed in the course of rheumatoid meningitis. Rheumatoid meningitis, which is one of the rarest involvements in the course of RA, may present with headaches, focal neurological deficits, seizures, and altered consciousness. A meningeal biopsy is recommended when the differential diagnosis cannot be ruled out with imaging and laboratory findings. In the differential diagnosis Mucobacterium tuberculosis, syphilis, neuro-sarcoidosis, immunoglobulin G4-related disease, lymphoproliferative diseases, and systemic metastasis should be kept in mind. Aggressive RA management is recommended for treatment.
Topics: Humans; Retrospective Studies; Magnetic Resonance Imaging; Meningitis; Arthritis, Rheumatoid; Diagnosis, Differential
PubMed: 36718604
DOI: 10.1093/mrcr/rxad010 -
Nature Communications Jan 2022Meningeal lymphatic vessels have been described in animal studies, but limited comparable data is available in human studies. Here we show dural lymphatic structures...
Meningeal lymphatic vessels have been described in animal studies, but limited comparable data is available in human studies. Here we show dural lymphatic structures along the dural venous sinuses in dorsal regions and along cranial nerves in the ventral regions in the human brain. 3D T2-Fluid Attenuated Inversion Recovery magnetic resonance imaging relies on internal signals of protein rich lymphatic fluid rather than contrast media and is used in the present study to visualize the major human dural lymphatic structures. Moreover we detect direct connections between lymphatic fluid channels along the cranial nerves and vascular structures and the cervical lymph nodes. We also identify age-related cervical lymph node atrophy and thickening of lymphatics channels in both dorsal and ventral regions, findings which reflect the reduced lymphatic output of the aged brain.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Aging; Case-Control Studies; Cranial Sinuses; Epilepsy; Female; Glymphatic System; Humans; Lymph Nodes; Magnetic Resonance Imaging; Male; Meninges; Middle Aged; Phantoms, Imaging; Retrospective Studies; Sex Factors
PubMed: 35017525
DOI: 10.1038/s41467-021-27887-0 -
Neurology India 2022Hypertrophic pachymeningitis (HPM) is a unique disorder characterized by thickening and fibrosis of the dura mater. Clinically it presents with headache, cranial nerve... (Observational Study)
Observational Study
BACKGROUND
Hypertrophic pachymeningitis (HPM) is a unique disorder characterized by thickening and fibrosis of the dura mater. Clinically it presents with headache, cranial nerve palsies, and other focal neurological deficits. Two forms exist, one is primary, where all other causes have been excluded and the other is secondary where an identifiable cause exists. It is important to recognize these secondary causes as treatment depends on the etiology.
OBJECTIVE
To elucidate the various characteristics of HPM. To delineate clinical-radiological features that help differentiate secondary from primary causes and to understand treatment response and disease outcomes of HPM.
METHODS
This retrospective observational study included 33 patients who presented with radiological diagnosis of HPM from January 2014 to July 2019. Spontaneous intracranial hypotension patients were excluded. All patients were extensively evaluated for secondary causes and treatment outcomes were analyzed on follow-up.
RESULTS AND CONCLUSIONS
Secondary causes of HPM were present in 48% cases. The clue for primary causes is an associated Tolosa-Hunt syndrome. Secondary causes in our series are immunological, infection, and malignancy. Clues to differentiate primary from these secondary causes are clinical like myelopathy, seizures, poor response to immunosuppression; radiological like hypertrophic cranial nerves, infarcts, bony erosion, and leptomeningeal involvement. There are case reports in literature but large Indian studies are lacking. This manuscript presents a large cohort of cases with HPM, which helps differentiate primary from secondary causes, as management and prognosis depend on etiology. An algorithm depicting the approach to the management of HPM has been presented.
Topics: Humans; Magnetic Resonance Imaging; Meningitis; Cranial Nerve Diseases; Headache; Treatment Outcome; Hypertrophy; Dura Mater
PubMed: 36537427
DOI: 10.4103/0028-3886.364052 -
Cell Reports Nov 2022The trigeminal sensory innervation of the cranial meninges is thought to serve a nociceptive function and mediate headache pain. However, the activity of meningeal...
The trigeminal sensory innervation of the cranial meninges is thought to serve a nociceptive function and mediate headache pain. However, the activity of meningeal afferents under natural conditions in awake animals remains unexplored. Here, we used two- and three-dimensional two-photon calcium imaging to track the activity of meningeal afferent fibers in awake mice. Surprisingly, a large subset of afferents was activated during non-noxious conditions such as locomotion. We estimated locomotion-related meningeal deformations and found afferents with distinct dynamics and tuning to various levels of meningeal expansion, compression, shearing, and Z-axis motion. Further, these mechanosensitive afferents were often tuned to distinct directions of meningeal expansion or compression. Thus, in addition to their role in headache-related pain, meningeal sensory neurons track the dynamic mechanical state of the meninges under natural conditions.
Topics: Animals; Mice; Meninges; Neurons, Afferent; Headache; Locomotion
PubMed: 36384109
DOI: 10.1016/j.celrep.2022.111648 -
Nature Reviews. Neurology Aug 2023Growing evidence from cerebrospinal fluid samples and post-mortem brain tissue from individuals with multiple sclerosis (MS) and rodent models indicates that the... (Review)
Review
Growing evidence from cerebrospinal fluid samples and post-mortem brain tissue from individuals with multiple sclerosis (MS) and rodent models indicates that the meninges have a key role in the inflammatory and neurodegenerative mechanisms underlying progressive MS pathology. The subarachnoid space and associated perivascular spaces between the membranes of the meninges are the access points for entry of lymphocytes, monocytes and macrophages into the brain parenchyma, and the main route for diffusion of inflammatory and cytotoxic molecules from the cerebrospinal fluid into the brain tissue. In addition, the meningeal spaces act as an exit route for CNS-derived antigens, immune cells and metabolites. A number of studies have demonstrated an association between chronic meningeal inflammation and a more severe clinical course of MS, suggesting that the build-up of immune cell aggregates in the meninges represents a rational target for therapeutic intervention. Therefore, understanding the precise cell and molecular mechanisms, timing and anatomical features involved in the compartmentalization of inflammation within the meningeal spaces in MS is vital. Here, we present a detailed review and discussion of the cellular, molecular and radiological evidence for a role of meningeal inflammation in MS, alongside the clinical and therapeutic implications.
Topics: Humans; Multiple Sclerosis; Gray Matter; Cerebral Cortex; Meninges; Inflammation; Disease Progression
PubMed: 37400550
DOI: 10.1038/s41582-023-00838-7 -
Clinical Anatomy (New York, N.Y.) Jan 2021The motion of the brain relative to the skull is influenced by the architecture of the subarachnoid space (SAS), and in particular, by the arachnoid trabeculae. In...
INTRODUCTION
The motion of the brain relative to the skull is influenced by the architecture of the subarachnoid space (SAS), and in particular, by the arachnoid trabeculae. In previous studies of these structures, specific shapes were identified. However, the work presented here shows much finer detail of the SAS geometries using SEM and TEM.
MATERIALS AND METHODS
These images were acquired by maintaining the SAS structure of a rat using glutaraldehyde formaldehyde to strengthen the tissues via crosslinking with the biological proteins.
RESULTS
The results showed the detailed shape of five dominant arachnoid trabeculae structures: single strands, branched strands, tree like shapes, sheets, and trabecular networks. Each of these architectures would provide a different response when exposed to a tensile load and would provide different levels of resistance to the flow of the cerebrospinal fluid (CSF) within the SAS.
CONCLUSION
This very detailed level of geometric information will therefore allow more accurate finite element models of the SAS to be developed.
Topics: Animals; Meninges; Microscopy, Electron; Rats; Rats, Sprague-Dawley; Subarachnoid Space
PubMed: 32519396
DOI: 10.1002/ca.23635 -
Annals of Medicine Dec 2023Tuberculous meningitis is an infectious disease of the central nervous system caused by Mycobacterium tuberculosis (M. tuberculosis). It mainly involves the meninges... (Review)
Review
Tuberculous meningitis is an infectious disease of the central nervous system caused by Mycobacterium tuberculosis (M. tuberculosis). It mainly involves the meninges and brain parenchyma, as well as the spinal cord and meninges; Disability and mortality rates are high. In recent years, due to the increase of drug-resistant tuberculosis patients, population mobility and the prevalence of acquired immune deficiency syndrome, the incidence rate of tuberculosis has increased significantly, and tuberculous meningitis has also increased. At present, tuberculosis is still a worldwide infectious disease that seriously threatens human health, especially in underdeveloped and developing countries. China is the largest developing country in the world with a large population. The situation of tuberculosis prevention and control is grim. Its disability rate is the highest in tuberculosis infection. In addition to the common non-specific manifestations, tuberculous meningoencephalitis may also have rare manifestations of stroke, hearing loss and visual loss. Understanding and timely improvement of corresponding examinations and targeted treatment will help improve the prognosis of patients.
Topics: Humans; Tuberculosis, Meningeal; Mycobacterium tuberculosis; Brain; Meningoencephalitis; China
PubMed: 36598144
DOI: 10.1080/07853890.2022.2164348 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2024The article presents a case of idiopathic hypertrophic pachymeningitis of a 61-year-old male patient with severe cephalgia and progressive neuropathy of the oculomotor...
The article presents a case of idiopathic hypertrophic pachymeningitis of a 61-year-old male patient with severe cephalgia and progressive neuropathy of the oculomotor nerves. The diagnosis was confirmed by MRI with gadolinium, which revealed thickening of the dura mater with accumulation of paramagnetic in the convexital parts of the frontal and temporal regions, as well as on the base of the skull and tentorium. During the use of pulse therapy with glucocorticosteroids (GCS) the symptoms regressed, but when the therapy was stopped, there was a relapse of ptosis and oculomotor abnormalities on the other side followed by a slower effect of GCS therapy. The article also presents a brief review of current knowledge about this pathology.
Topics: Male; Humans; Middle Aged; Skull; Meningitis; Magnetic Resonance Imaging; Hypertrophy
PubMed: 38529871
DOI: 10.17116/jnevro2024124031114