Blood-CSF-barrier dysfunction is a marker for encephalitic involvement in patients with aseptic
Background:
The term "aseptic meningitis" encompasses cases of meningitis with negative bacterial CSF culture, which predominantly are of viral etiology. While the clinical course is usually benign, complications such as encephalitic involvement resulting in a more severe clinical course may occur. Dysfunction of the blood-brain-barrier (BBB), which is a prerequisite for viral entry into the brain parenchyma, can be approximated using the CSF/serum albumin ratio, readily obtainable in routine CSF analysis.
Objecitves:
Analysis of CSF patterns in patients with aseptic meningitis/meningoencephalitis with a focus on BBB dysfunction as a marker for encephalitic involvement.
Study Design:
Retrospective chart review of patients admitted to our hospital between 2004 and 2016 with a diagnosis of aseptic meningitis/meningoencephalitis.
Results:
Patients with aseptic meningitis displaying clinical, MR-tomographic or electroencephalographic signs of encephalitic involvement were significantly older than patients without these features (47.4 vs. 35.5 yrs., p=0.002). In patients with meningoencephalitis, CSF analysis revealed a more severe disruption of BBB, approximated by the CSF/serum albumin ratio (p=0.002). Compromised BBB function correlated positively with length of hospitalization (p=0.007), indicative of a more severe clinical course. The number of CSF lymphocytes was found to predict the severity of the BBB disruption, which additionally was more frequently observed when herpesviridae were identified as infectious agents.
Conclusions:
We suggest that the CSF/serum albumin ratio as an estimate for BBB function should be attended to in the evaluation of patients with aseptic meningitis. Severe BBB dysfunction, older age and infection with herpesviridae appear to raise the risk for encephalitic involvement.
Insights
Aseptic meningitis can involve the brain, indicated by blood-brain barrier (BBB) dysfunction. The CSF/serum albumin ratio helps identify this dysfunction, predicting a more severe clinical course and risk of encephalitic involvement.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- Aseptic meningitis, often viral, typically has a benign course but can lead to severe encephalitic involvement.
- Blood-brain barrier (BBB) dysfunction is crucial for viral entry into the brain parenchyma.
- The CSF/serum albumin ratio serves as a practical marker for assessing BBB integrity.
Purpose of the Study:
- To analyze cerebrospinal fluid (CSF) patterns in aseptic meningitis/meningoencephalitis.
- To evaluate BBB dysfunction as an indicator of encephalitic involvement.
- To correlate BBB integrity with clinical outcomes and etiological factors.
Main Methods:
- Retrospective chart review of patients diagnosed with aseptic meningitis/meningoencephalitis between 2004 and 2016.
- Analysis of CSF parameters, including the CSF/serum albumin ratio and lymphocyte count.
- Correlation of BBB dysfunction markers with clinical, imaging, and electroencephalographic findings.
Main Results:
- Patients with encephalitic involvement were significantly older (47.4 vs. 35.5 years).
- A more severe BBB disruption, indicated by a higher CSF/serum albumin ratio, was observed in meningoencephalitis cases (p=0.002).
- Compromised BBB function correlated with longer hospitalization (p=0.007) and was more frequent with herpesviridae infections.
Conclusions:
- The CSF/serum albumin ratio is a valuable tool for assessing BBB function in aseptic meningitis.
- Severe BBB dysfunction, advanced age, and herpesviridae infections are risk factors for encephalitic involvement.
- Monitoring BBB integrity aids in predicting disease severity and guiding patient management.
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