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Lumbar puncture with cerebrospinal fluid results demonstrating aseptic meningitis pattern is necessary for diagnosis and polymerase chain reaction is used to detect viral presence. [4] Although symptoms are self-limiting, treatment with antiviral medication may be recommended to prevent progression to Herpes Meningoencephalitis .
The initial test is usually a lumbar puncture to collect cerebrospinal fluid for analysis. The lumbar puncture in chronic meningitis usually shows a lymphocytic predominant inflammatory pattern, however, some infectious agents such as early tuberculosis meningitis, nocardia or brucella may have an neutrophilic predominant inflammation. [2]
A cerebrospinal fluid sample is taken by lumbar puncture and is tested for leukocyte levels to determine if there is an infection and goes on to further testing to see what the actual cause is. The symptoms are the same for both meningitis and aseptic meningitis but the severity of the symptoms and the treatment can depend on the certain cause.
There are no specific signs or symptoms that can indicate meningitis, and a lumbar puncture (spinal tap) to examine the cerebrospinal fluid is recommended for diagnosis. [47] Lumbar puncture is contraindicated if there is a mass in the brain (tumor or abscess) or the intracranial pressure (ICP) is elevated, as it may lead to brain herniation.
Viral meningitis has no evidence of bacteria present in cerebral spinal fluid (CSF). Therefore, lumbar puncture with CSF analysis is often needed to identify the disease. [5] In most cases, there is no specific treatment, with efforts generally aimed at relieving symptoms (headache, fever or nausea). [6]
Illustration depicting lumbar puncture (spinal tap) Spinal needles used in lumbar puncture Illustration depicting common positions for lumbar puncture procedure. The person is usually placed on their side (left more commonly than right). The patient bends the neck so the chin is close to the chest, hunches the back, and brings knees toward the ...
During the lumbar puncture procedure, the opening pressure is measured. A pressure of over 180 mm H 2 O is suggestive of bacterial meningitis. It is likely that Mollaret meningitis is underrecognized by physicians, and improved recognition may limit unwarranted antibiotic use and shorten or eliminate unnecessary hospital admission. [12]
Lumbar puncture would be performed to collect cerebral spinal fluid (CSF) to culture for bacterial growth. Growth indicated a bacterial meningitis, while no growth indicated another cause denoted "aseptic" meningitis. [1] The most common form of this is viral meningitis. [1]