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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]
Meningitis can be life-threatening because of the inflammation's proximity to the brain and spinal cord; therefore, the condition is classified as a medical emergency. [2] [8] A lumbar puncture, in which a needle is inserted into the spinal canal to collect a sample of cerebrospinal fluid (CSF), can diagnose or exclude meningitis. [1] [8]
Herpes meningitis is typically self-limiting over 2 weeks without treatment. However, empirical use of antiviral medications such as acyclovir are considered in cases of suspected HSV meningitis to prevent progression to the more rapid and fatal HSV meningoencephalitis. [7] HSV-2 is the most common herpes virus that causes meningitis. [3]
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.
A lumbar puncture can give the symptom of a post-dural-puncture headache. A cerebrospinal fluid leak can be either cranial or spinal, and these are two different disorders. [5] A spinal CSF leak can be caused by one or more meningeal diverticula or CSF-venous fistulas not associated with an epidural leak.
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 ...
The diagnosis is based on symptoms and a high opening pressure found during a lumbar puncture with no specific cause found on a brain scan. [1] [2] Treatment includes a healthy diet, salt restriction, and exercise. [2] The medication acetazolamide may also be used along with the above measures. [2]
Tuberculous-meningitis-autopsy, showing associated brain oedema and congestion. Diagnosis of TB meningitis is made by analysing cerebrospinal fluid collected by lumbar puncture. When collecting CSF for suspected TB meningitis, a minimum of 1 ml of fluid should be taken (preferably 5 to 10 ml).
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