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Viral Meningitis Differential Diagnoses

  • Author: Cordia Wan, MD; Chief Editor: Niranjan N Singh, MD, DM  more...
Updated: Apr 28, 2016

Diagnostic Considerations

In very young patients, the signs and symptoms of viral meningitis are not "textbook," and a high index of suspicion is required for accurate diagnosis and management. The elderly may also present with atypical signs and symptoms.

For the clinician, as previously mentioned, consideration of other pathogens, such as bacteria, mycoplasma, and fungi, is crucial. Partially untreated bacterial meningitis in particular can manifest similarly to viral meningitis. These are treatable pathogens that can have devastating outcomes if misdiagnosed.

The clinician should also realize that the picture of aseptic meningitis is created not only by infectious agents, but also by chemical irritation (chemical meningitis), neoplasm (meningitis carcinomatous), granulomatous disorders, and other inflammatory conditions.

In addition to the differentials listed in the next section, mimics of viral meningitis include the following:

  • Partially treated bacterial meningitis
  • Parameningeal infection
  • Coccidioides immitis infection
  • Cryptococcus neoformans infection
  • Histoplasma capsulatum infection
  • Candida species infection
  • Blastomyces dermatitidis infection
  • Mycoplasma infection
  • Listeria infection
  • Leptospira infection
  • Drugs
  • Heavy metals
  • Surgically implanted materials
  • Sjögren syndrome
  • Behçet disease
  • Electroencephalogram in neurologic infections
  • Cytomegalovirus encephalitis
  • Abnormal neonatal electroencephalogram
  • Low-grade astrocytoma
  • Lumbar puncture (CSF Examination)
  • Electroencephalogram in status epilepticus
  • Leptomeningeal carcinomatosis
  • Migraine variants
  • Neurocysticercosis
  • Neurosarcoidosis
  • Subdural empyema
  • Varicella zoster
  • Hydrocephalus
  • Brucellosis
  • Lyme disease
  • Neurosyphilis
  • Brucellosis

Differential Diagnoses

Contributor Information and Disclosures

Cordia Wan, MD Adult Neurologist, Kaiser Permanente Hawaii, Kaiser Permanente Southern California

Cordia Wan, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.


Amir Vokshoor, MD Staff Neurosurgeon, Department of Neurosurgery, Spine Surgeon, Diagnostic and Interventional Spinal Care, St John's Health Center

Amir Vokshoor, MD is a member of the following medical societies: Alpha Omega Alpha, North American Spine Society, American Association of Neurological Surgeons, American Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Florian P Thomas, MD, PhD, Drmed, MA, MS Director, National MS Society Multiple Sclerosis Center; Professor and Director, Clinical Research Unit, Department of Neurology, Adjunct Professor of Physical Therapy, Associate Professor, Institute for Molecular Virology, St Louis University School of Medicine; Editor-in-Chief, Journal of Spinal Cord Medicine

Florian P Thomas, MD, PhD, Drmed, MA, MS is a member of the following medical societies: Academy of Spinal Cord Injury Professionals, American Academy of Neurology, American Neurological Association, Consortium of Multiple Sclerosis Centers, National Multiple Sclerosis Society, Sigma Xi

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MD, DM Associate Professor of Neurology, University of Missouri-Columbia School of Medicine

Niranjan N Singh, MD, DM is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, American Headache Society

Disclosure: Nothing to disclose.

Additional Contributors

J Stephen Huff, MD, FACEP Professor of Emergency Medicine and Neurology, Department of Emergency Medicine, University of Virginia School of Medicine

J Stephen Huff, MD, FACEP is a member of the following medical societies: American Academy of Neurology, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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T1-weighted MRI of brain demonstrates diffuse enhancement of the meninges in viral meningoencephalitis.
This rash consists of an enlarging annular plaque. Image courtesy of Lyme Disease Network (
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