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Aseptic Meningitis With an Isolated Positive Ocular Globe Compression Sign Diagnosed by Repeat Lumbar Puncture
Yuichiro Mine1, Taiju Miyagami2, Satoshi Furuya2
1Clinical Training Center, Juntendo University Hospital, Tokyo, JPN.
Abstract:
Aseptic meningitis is diagnosed using clinical and laboratory findings of meningeal inflammation in the absence of bacteria in cerebrospinal fluid smear and culture. It is commonly caused by a viral infection, and most cases are improved without specific treatment. We present a case of aseptic meningitis in a 33-year-old Japanese man that was diagnosed only after a repeat lumbar puncture. The patient had a positive ocular globe compression sign with no other positive meningeal signs. This case highlights the importance of repeated lumbar puncture in patients with suspected aseptic meningitis if the initial lumbar puncture results are negative, and there is a clinical value in assessing the ocular globe compression sign, particularly when other clinical signs of meningitis are absent.
Insights
Aseptic meningitis diagnosis may require repeat lumbar puncture if initial tests are negative. The ocular globe compression sign can aid diagnosis when other symptoms are absent.
Area of Science:
- Neurology
- Infectious Diseases
- Clinical Diagnostics
Background:
- Aseptic meningitis involves meningeal inflammation without bacterial infection, often viral.
- Most cases resolve without specific intervention.
- Diagnosis relies on clinical presentation and cerebrospinal fluid analysis.
Observation:
- A 33-year-old Japanese man presented with symptoms suggestive of aseptic meningitis.
- Initial lumbar puncture results were negative, delaying diagnosis.
- The patient exhibited a positive ocular globe compression sign, but lacked other meningeal signs.
Findings:
- A second lumbar puncture was crucial for confirming the aseptic meningitis diagnosis.
- The ocular globe compression sign proved valuable in this diagnostic challenge.
- Negative initial CSF findings can occur despite clinical suspicion.
Implications:
- Repeated lumbar puncture is vital for suspected aseptic meningitis with inconclusive initial results.
- The ocular globe compression sign is a clinically relevant diagnostic indicator.
- This case underscores the need for thorough evaluation in challenging meningitis cases.
