Pediatric Aseptic Meningitis Differential Diagnoses

Updated: Sep 17, 2018
  • Author: Saul N Faust, MBBS, PhD, MA, MRCPCH(UK); Chief Editor: Russell W Steele, MD  more...
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Diagnostic Considerations

Missed meningitis is one of the most frequent causes of lawsuits in pediatrics, leading to large claims. Therefore, a high index of suspicion is needed, and accurate charting of pertinent positive and negative findings is crucial. In terms of total damages per year, missed meningitis is second only to missed myocardial infarction. Because of the frequency of neurologic sequelae, many lawsuits are filed even though treatment was promptly instituted.

A critical diagnostic issue involves differentiating aseptic meningitis from bacterial meningitis. To this end, clinical decision rules have been formulated (eg, the Bacterial Meningitis Score developed by Nigrovic et al [41] ). These rules identify patients who are at low risk for bacterial meningitis by scoring or modeling clinical variables, blood variable, and cerebrospinal fluid (CSF) variables. The Bacterial Meningitis Score has shown high accuracy and usability and continues to be evaluated. [42]

In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:

  • Viral encephalitis

  • Meningoencephalitis

  • Acute disseminated encephalomyelitis (ADEM)

  • Atypical migraine

  • Hydrocephalus

Differential Diagnoses