Pediatric Aseptic Meningitis Differential Diagnoses

Updated: Mar 15, 2019
  • Author: Daniel Owens, BM, MRCPCH(UK); Chief Editor: Russell W Steele, MD  more...
  • Print

Diagnostic Considerations

Missed meningitis is one of the most frequent causes of lawsuits in pediatrics, leading to large claims. [50, 51] Therefore, a high index of suspicion is needed, and accurate charting of pertinent positive and negative findings is crucial Claims relating to meningitis are the second most common claim in pediatrics in the USA (behind Brain-damaged infant). [50] Litigation related to meningitis commonly focuses on a missed diagnosis which entails high expenses and defence fees.

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. [52]  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. [53, 54]

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

Viral encephalitis


Acute disseminated encephalomyelitis (ADEM)

Atypical migraine


Differential Diagnoses