Viral Meningitis Differential Diagnoses

Updated: Jul 17, 2018
  • Author: Cordia Wan, MD; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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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