Related Experiment Video

Updated: Jul 7, 2026

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
09:53

Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

Published on: July 5, 2021

Chemical meningitis following cerebellopontine angle tumor surgery

Gabriela B Sanchez1, David M Kaylie, Matthew R O'Malley

  • 1Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA. Gabriela.sanchez@vanderbilt.edu

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|March 4, 2008
PubMed
Abstract

Insights

Postoperative chemical meningitis can mimic bacterial meningitis. Mild cerebrospinal fluid (CSF) leukocytosis and normal CSF glucose may indicate chemical meningitis, avoiding unnecessary antibiotic treatment.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Neurosurgery

Background:

  • Postoperative chemical meningitis presents diagnostic challenges, often mimicking bacterial meningitis until cerebrospinal fluid (CSF) culture results are available.
  • Differentiating chemical meningitis from bacterial meningitis is crucial for appropriate patient management and to avoid unnecessary antibiotic exposure.

Purpose of the Study:

  • To identify clinical and laboratory findings that can reliably exclude bacterial meningitis in postoperative patients.
  • To aid in the early diagnosis and management of postoperative chemical meningitis.

Main Methods:

  • Retrospective chart review of 1146 patients who developed meningitis after cerebellopontine angle surgery.
  • Comparison of clinical symptoms, CSF profiles, and serum white blood cell (WBC) counts between patients with chemical meningitis, bacterial meningitis, and asymptomatic controls.
  • Analysis of lumbar puncture data from asymptomatic postoperative patients as a control group.

Main Results:

  • The incidence of meningitis was 4.54%, with 0.87% being culture-proven bacterial meningitis.
  • Bacterial meningitis cases showed significantly higher CSF and serum WBC counts and lower CSF glucose levels compared to chemical meningitis.
  • Asymptomatic patients had a significantly lower CSF WBC to red blood cell (RBC) ratio than patients with chemical meningitis.

Conclusions:

  • Patients presenting with mild CSF leukocytosis, normal CSF glucose, normal serum WBC counts, and no focal neurological deficits may be treated for chemical meningitis.
  • These findings can help clinicians differentiate chemical from bacterial meningitis, guiding treatment decisions.
  • Early identification of chemical meningitis can prevent prolonged antibiotic use and associated complications.

More Related Videos

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas07:43

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

Microvascular Decompression: Salient Surgical Principles and Technical Nuances10:35

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Published on: July 5, 2011

Related Concept Videos

Cryptococcal Meningitis01:27

Cryptococcal Meningitis

Cryptococcal meningitis is a life-threatening opportunistic infection predominantly associated with HIV/AIDS, accounting for over 100,000 deaths annually worldwide. However, it also affects individuals with other forms of immunosuppression, including those undergoing immunosuppressive therapy, organ transplant recipients, patients with innate immunodeficiencies, and individuals with hematological disorders. The infection is caused mainly by Cryptococcus neoformans and Cryptococcus gattii,...
Bacterial Meningitis I: Introduction01:22

Bacterial Meningitis I: Introduction

Bacterial meningitis is a severe, life-threatening inflammation of the meninges, particularly the pia mater and arachnoid mater, affecting the subarachnoid space, ventricles, and cerebrospinal fluid (CSF). If untreated, it can lead to significant neurological complications or death.Causative AgentsCommon pathogens vary with age and immune status. In adults, major organisms include Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae. Streptococcus agalactiae (group B...
Bacterial Meningitis II: Pathophysiology01:26

Bacterial Meningitis II: Pathophysiology

Bacterial meningitis typically begins when pathogens such as Neisseria meningitidis and Streptococcus pneumoniae colonize the nasopharynx and invade the bloodstream. This process is facilitated by bacterial virulence factors, such as polysaccharide capsules, which resist phagocytosis and complement-mediated killing. Less commonly, bacteria reach the central nervous system via contiguous spread from infections like otitis media or sinusitis, through congenital or acquired dural defects, or...
Bacterial Meningitis01:24

Bacterial Meningitis

Bacterial meningitis is a severe infectious disease involving inflammation of the meninges, the protective membranes surrounding the brain and spinal cord. It occurs when pathogenic bacteria cross the blood–brain barrier and enter the cerebrospinal fluid. Common causative organisms include Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b, Listeria monocytogenes, and Escherichia coli K1. The exact route of entry varies by pathogen and host condition.Routes of Entry...
Viral Meningitis01:18

Viral Meningitis

Viral meningitis is the most common form of meningitis and is often referred to as aseptic meningitis to indicate the absence of bacterial involvement. It is generally milder than bacterial meningitis, with symptoms including fever, headache, stiff neck, drowsiness, nausea, photophobia, and vomiting. Rarely, more severe manifestations or death may occur. Common causative agents include enteroviruses, particularly coxsackie A and B viruses and echoviruses, all members of the Enterovirus genus...
Brain Abscess l: Introduction01:26

Brain Abscess l: Introduction

A brain abscess is a focal, intracerebral infection characterized by a localized collection of pus within the brain parenchyma, resulting from microbial invasion and the body’s inflammatory response. It progresses through stages: early and late cerebritis, followed by early and late capsule formation, reflecting tissue destruction, immune response, and eventual encapsulation.Etiology and PathogenesisCausative organisms vary with source and host factors, often involving polymicrobial infections,...