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Meningitis, Viral

Christine M. Broszko, MD and James E. Hougas, III, MD, FAAFP Reviewed 06/2018
 


BASICS

DESCRIPTION

  • A clinical syndrome characterized by signs/symptoms of acute meningeal inflammation from a viral etiology

  • Viral meningitis (VM) is the most common cause of aseptic meningitis (no iden...

DIAGNOSIS

HISTORY

Predominant symptoms include acute onset (hours to days) of: 
  • Fever (in 76–100% of patients)

  • Headache (prominent early symptom)

  • Photophobia

  • Myalgias

  • Nausea, vomiting

  • Malaise

  • Nuchal rigidity ...

TREATMENT

GENERAL MEASURES

Management includes supportive care (e.g., pain control, IV fluids) and a low threshold for empiric antibiotics for BM. 

MEDICATION

First Line

  • Analgesics (adult doses; titrate d...

ONGOING CARE

FOLLOW UP RECOMMENDATIONS

Primary care follow-up to ensure resolution 

Patient Monitoring

  • Monitor for relapse or exacerbation of symptoms.

  • Monitor for neurologic/neuroendocrine complications:...

REFERENCES

1
Viallon A, Desseigne N, Marjollet O, et al. Meningitis in adult patients with a negative direct cerebrospinal fluid examination: value of cytochemical markers for differential diagnosis. C...

ADDITIONAL READING

  • Ciovacco WA, Baraff LJ. Lumbar puncture is not needed for all patients suspected to have viral meningitis. Ann Emerg Med.  2012;59(3):228–229. [View Abstract on OvidMedline]

  • Dr...

SEE ALSO

  • Meningitis, Bacterial

  • Algorithm: Delirium

CODES

ICD10

  • A87.9 Viral meningitis, unspecified

  • A87.1 Adenoviral meningitis

  • A87.0 Enteroviral meningitis

  • B00.3 Herpesviral meningitis

  • A87.2 Lymphocytic choriomeningitis

  • A87.8 Other viral meningitis

  • B02.1 Zos...

CLINICAL PEARLS

  • VM cannot be reliably distinguished from BM based on clinical findings alone.

  • Potential cases of BM should be hospitalized for evaluation and treatment with broad-spectrum antibiotics u...

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