The best part of working in the Emergency Department at Carolinas Medical Center is being surrounded by so many brilliant colleagues. I learn something new every shift (and, in truth, is where the majority of these Morsels are baked). Today’s Morsel is a reflection of that fact.
We evaluate headache often. With the mantra of “worst first” echoing in our ears we naturally consider meningitis, but, fortunately, we are often able to exclude it based on our exam. In previous Morsels, we have discussed concerning characteristics of headaches as well as some interesting causes of headaches (AVM, meningococcemia, pseudotumor). What if, however, the patient has had viral meningitis previously? What is Mollaret’s Meningitis anyway?
Recurrent Meningitis
Can be separated into two main categories:
Recurrent Bacterial Meningitis
Bacterial meningitis untreated is almost always fatal.
Recurrence implies that it was treated, but there is an underlying cause for the bacteria to gain access to the CSF again. Examples:
Congenital middle ear abnormalities
Persistent dermal sinus along the spinal column
Basilar skull fractures
Sinusitis, Mastoiditis, Deep Space Abscess
Immunodeficiencies
Recurrent Non-purulent Meningitis
Recurrent non-purulent meningitis can be due to a wide variety of entities including infectious as well as non-infectious causes.
Infectious
Bacteria, spirochetes, fungi, protozoa,viruses.
Non-Infectious
Tumors (ex, epidermoid cysts and craniopharyngioma)
Poulikakos PJ1, Sergi EE, Margaritis AS, Kioumourtzis AG, Kanellopoulos GD, Mallios PK, Dimitrakis DJ, Poulikakos DJ, Aspiotis AA, Deliousis AD, Flevaris CP, Zacharof AK. A case of recurrent benign lymphocytic (Mollaret’s) meningitis and review of the literature. J Infect Public Health. 2010 Dec;3(4):192-5. PMID: 21126724. [PubMed] [Read by QxMD]
Mollaret’s meningitis is a rare form of benign recurrent aseptic meningitis first described in 1944. We report a case of Mollaret’s meningitis due to Herpes Simplex Virus type 2 (HSV2), diagnosed with Polymerase Chain Reaction (PCR) implementation in the Cerebrospinal fluid (CSF) of the patient and treated successfully with acyclovir. To our knowledge, this is the first case of Mollaret’s meningitis reported in Greece. We reviewed the literature […]
Abu Khattab M1, Al Soub H, Al Maslamani M, Al Khuwaiter J, El Deeb Y. Herpes simplex virus type 2 (Mollaret’s) meningitis: a case report. Int J Infect Dis. 2009 Nov;13(6):e476-9. PMID: 19329344. [PubMed] [Read by QxMD]
Mollaret’s meningitis is an unusual and under-appreciated syndrome of benign, recurrent aseptic meningitis. The available literature indicates that the causative agent is herpes simplex virus type 2 (HSV-2) in the majority of cases and much less frequently herpes simplex virus type 1 (HSV-1). […]
Davis LE. Acute and recurrent viral meningitis. Curr Treat Options Neurol. 2008 May;10(3):168-77. PMID: 18579020. [PubMed] [Read by QxMD]
Acute viral meningitis is the most common infection of the central nervous system. Most cases occur in children and young adults and are due to enteroviruses. Although the common causes of acute viral meningitis still lack treatment with an effective antiviral agent, management of patients is changing because of better and more rapid diagnostic tests to determine the exact viral etiology. These tests reduce the cost of workups and shorten hospita […]
Capouya JD1, Berman DM, Dumois JA. Mollaret’s meningitis due to human herpesvirus 6 in an adolescent. Clin Pediatr (Phila). 2006 Nov;45(9):861-3. PMID: 17041177. [PubMed] [Read by QxMD]
We report the first pediatric case of Mollaret meningitis in an adolescent female with acute lymphoblastic leukemia in remission. This patient had signs and symptoms consistent with meningitis, with three episodes over a 3-month period. Human herpesvirus 6 (HHV-6) was identified during her last episode from polymerase chain reaction assay of a cerebrospinal fluid specimen. She was treated successfully with foscarnet, after which HHV-6 was undetec […]
I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.
I enjoy taking care of patients and I finding it endlessly rewarding to help train others to do the same. I trained at the Combined Emergency Medicine and Pediatrics residency program at University of Maryland, where I had the tremendous fortune of learning from world renowned educators and clinicians. Now I have the unbelievable honor of working with an unbelievably gifted group of practitioners at Carolinas Medical Center. I strive every day to inspire my residents as much as they inspire me.
[…] Mollarets meningit: Återkommande meningit, bakteriell eller viral. […]
[…] diagnosed the patient with Mollaret's meningitis and started him on continuous suppressive …The results of all radiological and biochemical tests were normal, but the patient reported a correl…ve […]
I didn’t know you were at Carolinas Medical Center! I am just up the road in Winston-Salem. I really enjoy the work you do with these morsels. I work at a community hospital, Thomasville Medical Center. Single MD coverage with several mid-levels. We see about 36,000 patients per year and weird pediatric pathology walks, or is carried, through the door way more frequently than you might imagine. Your emails really help me in my practice. Thank you!
[…] Mollarets meningit: Återkommande meningit, bakteriell eller viral. […]
[…] diagnosed the patient with Mollaret's meningitis and started him on continuous suppressive …The results of all radiological and biochemical tests were normal, but the patient reported a correl…ve […]
I didn’t know you were at Carolinas Medical Center! I am just up the road in Winston-Salem. I really enjoy the work you do with these morsels. I work at a community hospital, Thomasville Medical Center. Single MD coverage with several mid-levels. We see about 36,000 patients per year and weird pediatric pathology walks, or is carried, through the door way more frequently than you might imagine. Your emails really help me in my practice. Thank you!
Mike Capriola