Teaching Pearls – Thanks to Dr. Sharma for joining us!

• Viral Meningitis Differential: Viral causes of meningitis includes EBV, WNV, HSV2, HSV-1, enterovirus, VZV, mumps
  • The most common viral meningitis cause is enterovirus which includes Cocksackie virus. Usually presents in the summer and fall, fecal-oral transmission, often mild and self-resolving.
  • Remember that HSV1 usually causes encephalitis while HSV2 causes a recurrent self-limited meningitis (Mollarets meningitis)
  • West Nile Virus can present with asymmetric flacid paralysis
  • VZV meningitis usually causes a more severe meningitis than HSV, make sure to check skin for dermatomal rash (particularly on the back where the patient may not be aware)
• Other non-viral causes of aseptic meningitis includes drug induced (Ibuprofen is classic, ranitidine), rheumatologic (SLE, Behcets), sarcoidosis.
• Ramsay Hunt Syndrome is VZV reactivation causing ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal and auricle
• VZV meningitis causes CSF pleocytosis and elevated protein level
• VZV CNS infections can cause strokes via infection of the cerebral arteries
• Causes of hypoglycorrhachia: Bacterial, TB, Rheumatologic
• Very elevated CSF protein is associated with hydrocephalus