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

Workup

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Media Gallery

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 (http://www.lymenet.org/).

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Author

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.

Coauthor(s)

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, MA, MS Chair, Neuroscience Institute and Department of Neurology, Director, Hereditary Neuropathy Center, Co-Director, Center for Memory Loss and Brain Health, Co-Director, ALS Center, Hackensack University Medical Center; Associate Dean of Faculty, Founding Chair and Professor, Department of Neurology, Hackensack Meridian School of Medicine

Florian P Thomas, MD, PhD, 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, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Chief Editor

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM Adjunct Associate Professor of Neurology, University of Missouri-Columbia School of Medicine; Medical Director of St Mary's Stroke Program, SSM Neurosciences Institute, SSM Health

Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM 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.

Viral Meningitis Differential Diagnoses

Diagnostic Considerations

Differential Diagnoses

References

Tables

Contributor Information and Disclosures

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