VZV Meningitis 3/21/16

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

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