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

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...

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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