Overview of recurrent aseptic meningitis
Recurrent aseptic meningitis refers to recurrent episodes of meningitis with signs of meningeal irritation, such as fever and neck stiffness, and cerebrospinal fluid (CSF) examination showing lymphocytosis and mildly elevated proteins, with rapid spontaneous remission over several days, and complete disappearance of the symptoms in the inter-episode period. The disease was first described by Mollaret (1944), and was called aseptic meningitis or “Mollaret’s meningitis” because no pathogens could be found in the cerebrospinal fluid at that time. The disease is most common in children and young adults, and can affect both sexes.
Causes
The cause of the disease is unknown. Current thinking is that it is a viral infection.
Symptoms
1. Most cases begin with sudden onset of fever, nausea, vomiting, myalgia, and headache.
2. Transient neurological disturbances such as convulsions, hallucinations, delirium, coma, diplopia, unequal pupils, cerebral nerve palsy, and pathological signs have been reported.
3. Symptoms peak within a few hours and disappear completely after a few hours to a week, and the cerebrospinal fluid returns to normal.
4. The time between attacks ranges from a few days or weeks to months or years.
5. In patients with non-Mollaret meningitis etiology, the clinical manifestations are based on different etiologies with corresponding basic symptoms, e.g., SLE with pteroid erythema or discoid erythema on the face, skin sensitization to sunlight, renal damage, lupus cells found in the blood, and positive anti-dsDNA antibody and positive Sm antibody.
Examination
1.Laboratory examination
(1) Mollaret meningitis shows lymphocytosis in the cerebrospinal fluid, mild elevation of protein and normal sugar content. Mollaret cells can be found in the first 24 hours after the disease and decrease rapidly after 24 hours.
(2) In patients with non-Mollaret meningitis etiology, there are selective examinations according to different etiologies; for example, if suspected systemic lupus erythematosus, we can look for lupus cells, anti-dsDNA antibody, anti-Sm antibody and other diagnostic bases; those caused by herpes simplex virus should be detected by PCR in cerebrospinal fluid to find out the pathogens or the antibody of the virus is positive in the blood, and so on.
(3) Peripheral blood leukocyte count may be increased.
(4) Blood sedimentation is increased.
(5) Other selective tests include: routine blood, blood electrolytes, blood glucose, urea nitrogen, and urine routine.
2. Other auxiliary examinations
(1) X-ray radiography ① chest radiographs can detect foci of viral pneumonia. ② craniocerebral and sinus plain film can be found cranial osteomyelitis, paranasal sinusitis, mastoiditis.
(2) CT, MRI examination CT or MRI of the cranium can be normal in the early stage of the lesion, and when there are neurological complications, meningeal exudation can be seen, and subdural effusion of ventriculitis can be found. Enhanced MRI scan is more sensitive than enhanced CT scan for the diagnosis of meningitis. Enhanced MRI scan can show meningeal exudation and cortical reaction.
(3) Related tests Herpes simplex virus, anti-Sm antibody, lymphocytes, lupus cells, cerebrospinal fluid, deoxyribonucleic acid staining, platelets, and blood sedimentation.
Diagnosis
In the diagnosis of recurrent aseptic meningitis, Mollaret meningitis is usually diagnosed on the basis of recurrent episodes with rapid onset, fever, meningeal irritation, and cerebrospinal fluid mononucleosis, which resolves spontaneously over a period of several days to weeks without specific treatment.
Treatment
Treatment of recurrent aseptic meningitis depends on the cause. Since the cause of Mollaret’s meningitis has not been clarified, there is no specific treatment for it. If it is a herpes simplex virus infection, acyclovir (acyclic guanosine) should be used for intravenous treatment, the dosage of which is the same as that used for herpes simplex encephalitis, and acyclovir (acyclic guanosine) tablets should be taken orally between episodes to prevent reoccurrences. Newer antiviral drugs such as valacyclovir are more favorable for absorption after oral administration.
Prevention
1. Pay attention to strengthening the physical fitness and preventing upper respiratory tract infections.
2. Newborns and children should be actively immunized as required.
3. Comprehensive treatment to prevent recurrence.