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Primary Care Sep 2013Meningitis is defined as inflammation of the meninges, in almost all cases identified by an abnormal number of white blood cells in the cerebrospinal fluid and specific... (Review)
Review
Meningitis is defined as inflammation of the meninges, in almost all cases identified by an abnormal number of white blood cells in the cerebrospinal fluid and specific clinical signs/symptoms. Onset may be acute or chronic, and clinical symptoms of acute disease develop over hours to days. This article reviews the epidemiology, pathophysiology, clinical manifestations, diagnosis, and management of acute meningitis, and provides a list of key points for primary care practitioners. Aseptic and bacterial meningitis vary significantly and are discussed separately.
Topics: Age Factors; Anti-Infective Agents; Brain; Cerebrospinal Fluid; Haemophilus Vaccines; Humans; Meningism; Meningitis, Aseptic; Meningitis, Bacterial; Primary Health Care; Risk Factors; Tomography, X-Ray Computed; United States
PubMed: 23958365
DOI: 10.1016/j.pop.2013.06.001 -
Seminars in Neurology 2000In the past 10 years the epidemiology of bacterial meningitis has changed, with a decreased incidence of meningitis caused by Haemophilus influenzae and an increasing... (Review)
Review
In the past 10 years the epidemiology of bacterial meningitis has changed, with a decreased incidence of meningitis caused by Haemophilus influenzae and an increasing incidence of meningitis caused by penicillin- and cephalosporin-resistant strains of Streptococcus pneumoniae. Meningococcal meningitis has become an increasing threat to college students. Successful outcome from meningitis requires not only eradication of the bacterial pathogen but also management of the neurological complications of raised intracranial pressure, stroke, and seizure activity. In this article, the pathophysiology, etiology, clinical presentation, differential diagnosis, and management of acute bacterial meningitis are reviewed. The present recommendations for the use of dexamethasone in the treatment of this infection, the use of chemoprophylaxis, and the indications for vaccinations are included.
Topics: Acute Disease; Anti-Bacterial Agents; Bacterial Physiological Phenomena; Diagnosis, Differential; Humans; Meninges; Meningitis, Bacterial; Neisseria meningitidis; Streptococcus pneumoniae; Vaccines
PubMed: 11051294
DOI: 10.1055/s-2000-9393 -
Journal of Neurology Feb 2009Chronic meningitis is an inflammation of the meninges with subacute onset and persisting cerebrospinal fluid (CSF) abnormalities lasting for at least one month. Several... (Review)
Review
Chronic meningitis is an inflammation of the meninges with subacute onset and persisting cerebrospinal fluid (CSF) abnormalities lasting for at least one month. Several non-infectious and infectious etiologies are known to be causative. The wide range of different etiologies renders the approach to patients with this syndrome particularly difficult. There is no standardized diagnostic procedure, thus, taking an in depth history combined with a complete physical examination is mandatory in every patient.This review aims to present the current knowledge on etiology, neurological course of disease, diagnostic and therapeutic management steps of patients presenting with clinical signs and symptoms of chronic meningitis and meningoencephalitis. Still, the etiology of one third of patients remains unclear, reflecting the diagnostic challenge of this syndrome for each physician or neurologist, respectively. However, most patients with idiopathic chronic meningitis have a relatively good outcome.
Topics: Autoimmune Diseases of the Nervous System; Central Nervous System Parasitic Infections; Chronic Disease; Diagnosis, Differential; Humans; Meninges; Meningitis; Meningitis, Aseptic; Meningitis, Bacterial; Meningitis, Viral
PubMed: 19224317
DOI: 10.1007/s00415-009-0122-0 -
Current Neurology and Neuroscience... May 2002Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer. Notwithstanding frequent focal signs and... (Review)
Review
Neoplastic meningitis (NM) is a common problem in neuro-oncology, occurring in approximately 5% of all patients with cancer. Notwithstanding frequent focal signs and symptoms, NM is a disease that affects the entire neuraxis; therefore, staging and treatment need to encompass all cerebrospinal fluid (CSF) compartments. Central nervous system (CNS) staging of NM includes contrast-enhanced cranial computerized tomography or magnetic resonance imaging, contrast-enhanced spine magnetic resonance imaging or computerized tomographic myelography, and radionuclide CSF flow study. Treatment of NM involves involved-field radiotherapy of bulky or symptomatic disease sites and intra-CSF drug therapy. The inclusion of concomitant systemic therapy may benefit patients with NM and may obviate the need for intra-CSF chemotherapy. At present, intra-CSF drug therapy is confined to three chemotherapeutic agents (ie, methotrexate, cytosine arabinoside, and thio-triethylene thiophosphoramide) administered by a variety of schedules either by intralumbar or intraventricular drug delivery. Although treatment of NM is palliative with an expected median patient survival of 2 to 6 months, it often affords stabilization and protection from further neurologic deterioration in patients with NM.
Topics: Central Nervous System Neoplasms; Humans; Magnetic Resonance Imaging; Meninges; Meningitis; Neoplasm Metastasis; Neoplasm Staging
PubMed: 11937001
DOI: 10.1007/s11910-002-0081-7 -
Trends in Molecular Medicine Jun 2018The central nervous system (CNS) is an immunologically specialized tissue protected by a blood-brain barrier. The CNS parenchyma is enveloped by a series of overlapping... (Review)
Review
The central nervous system (CNS) is an immunologically specialized tissue protected by a blood-brain barrier. The CNS parenchyma is enveloped by a series of overlapping membranes that are collectively referred to as the meninges. The meninges provide an additional CNS barrier, harbor a diverse array of resident immune cells, and serve as a crucial interface with the periphery. Recent studies have significantly advanced our understanding of meningeal immunity, demonstrating how a complex immune landscape influences CNS functions under steady-state and inflammatory conditions. The location and activation state of meningeal immune cells can profoundly influence CNS homeostasis and contribute to neurological disorders, but these cells are also well equipped to protect the CNS from pathogens. In this review, we discuss advances in our understanding of the meningeal immune repertoire and provide insights into how this CNS barrier operates immunologically under conditions ranging from neurocognition to inflammatory diseases.
Topics: Animals; Central Nervous System; Disease Susceptibility; Homeostasis; Humans; Immune System; Immunity; Meninges; Meningitis
PubMed: 29731353
DOI: 10.1016/j.molmed.2018.04.003 -
Current Neurology and Neuroscience... Nov 2007Multidrug-resistant tuberculous meningitis is now appearing worldwide, including in the United States, and is difficult to diagnose and treat. We discuss methods to... (Review)
Review
Multidrug-resistant tuberculous meningitis is now appearing worldwide, including in the United States, and is difficult to diagnose and treat. We discuss methods to diagnose tuberculous meningitis, review current and experimental assays for determining drug resistance, and consider approaches to management of the patient. We review the epidemiology of multidrug-resistant tuberculosis and extensively drug-resistant tuberculosis in both pulmonary and meningeal infections, discuss promising molecular methods for determining drug resistance, and review current approaches toward treatment of patients. The incidence of multidrug-resistant tuberculous meningitis is increasing, and diagnosing and treating these patients will be a major challenge. There is a need to improve rapid methods of isolating the organism from cerebrospinal fluid, to advance molecular methods to rapidly test the isolate for antibiotic sensitivity, and to develop new antituberculosis drugs, especially ones that cross the blood-cerebrospinal fluid barrier.
Topics: Antibiotics, Antitubercular; Brain; Cerebrospinal Fluid; Colony Count, Microbial; Diagnostic Imaging; Drug Resistance, Multiple, Bacterial; Humans; Meninges; Mycobacterium tuberculosis; Tuberculosis, Meningeal
PubMed: 17999892
DOI: 10.1007/s11910-007-0073-8 -
Pediatric Emergency Care Dec 2003
Review
Topics: Adolescent; Ceftriaxone; Child; Clindamycin; Confusion; Drug Therapy, Combination; Humans; Hypertension; Male; Meningism; Meningitis, Pneumococcal; Shock, Septic; Sickle Cell Trait; Sphenoid Sinusitis; Vancomycin
PubMed: 14676492
DOI: 10.1097/01.pec.0000101584.65509.4b -
Journal of the American Medical... Sep 1950
Topics: Meninges; Tuberculosis, Meningeal
PubMed: 15436296
DOI: 10.1001/jama.1950.02920020012004 -
Archives of Pediatrics Oct 1946
Topics: Humans; Meninges; Tuberculosis; Tuberculosis, Meningeal
PubMed: 20274459
DOI: No ID Found -
American Review of Tuberculosis Jan 1948
Topics: Humans; Meninges; Tuberculosis; Tuberculosis, Meningeal
PubMed: 18917599
DOI: 10.1164/art.1948.57.1.63