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[Prolonged nonbacterial meningitis: clinical aspects and cerebrospinal fluid findings]
Insights
Prolonged aseptic meningitis in children can present with persistent symptoms and distinct cerebrospinal fluid (CSF) changes. Boys aged 6-15 showed more severe CSF abnormalities, indicating a prolonged inflammatory response.
Area of Science:
- Neurology
- Pediatrics
- Infectious Diseases
Context:
- Aseptic meningitis can lead to prolonged neurological symptoms in children.
- Causative agents include mumps virus and enteroviruses.
- Cerebral palsy may be a predisposing factor in some cases.
Purpose:
- To describe the clinical course and cerebrospinal fluid (CSF) findings in children with prolonged aseptic meningitis.
- To identify potential differences in disease progression based on age and sex.
Summary:
- 33 children (2-15 years) with aseptic meningitis showed persistent CSF abnormalities (elevated protein/cell count) 10-28 days post-admission.
- Two distinct CSF reaction patterns were observed: one with increased protein and minimal cells (all), and another with persistent elevation of both cells and protein, primarily in boys (6-15 years).
- Complications included facial paralysis and transient hypertension; neurological symptoms like headache and vomiting persisted for weeks/months.
Impact:
- Highlights the potential for prolonged illness and distinct CSF profiles in pediatric aseptic meningitis.
- Suggests sex-based differences in the inflammatory response and recovery patterns.
- Informs clinical management and prognosis for children with persistent aseptic meningitis.
Abstract:
Ten to 28 days after hospital admission cell count and/or total protein concentration showed no decrease or further increase in 33 children (25 boys, 8 girls) between 2 to 15-years of age who suffered from acute aseptic meningitis (causative agents: mumps virus in 9 children, enterovirus in 5 children). Three of these children had cerebral palsy as a possible predisposing factor. The onset of prolonged aseptic meningitis was protracted in some children. At hospital admission the clinical features of this disorder differed not from those in uncomplicated acute aseptic meningitis. In 4 children a one-sided and in 4 patients a doublesided peripheral facial paralysis occurred as a transitory complication. One child showed transient arterial hypertension. EEG was normal in most of the children or revealed a slight general slowing only. Apart from a slight enlargement of the ventricles in 3 children cerebral CT showed no abnormality. Complaints like vertigo, headache, and vomiting persisted for weeks or months in part of the children. During the course of the disease CSF reflected two different reactions: 1. further increase of total protein in combination with a minimal cellular response, affecting 2-10 years old boys and girls equally; protein electrophoresis revealing the pattern of severe blood-CSF barrier disturbance, 2. persistant elevation or further increase of both cell count and total protein occurring nearly exclusively in 6-15 years old boys, associated with the CSF-protein pattern of severe blood-CSF barrier disturbance and of oligoclonal gamma-fractions.(ABSTRACT TRUNCATED AT 250 WORDS)