The main basis for differentiating Richter’s syndrome from septic meningitis is cerebrospinal fluid examination, liver function tests and blood biochemical tests.
In patients with septic meningitis, inflammatory changes are often found on cerebrospinal fluid examination, whereas in Reye’s syndrome, apart from increased cerebrospinal fluid pressure, most routine cerebrospinal fluid and biochemical tests are normal. Abnormal liver function, elevated blood ammonia and hepatic steatosis are often present in Reye’s syndrome, but this is not present in septic meningitis.