Nonpolio Enteroviruses, Polioviruses, and Human CNS Infections
Sunit K. Singh, Daniel Růžek in Neuroviral Infections, 2013
Viral infection of the CNS can involve the meninges (meningitis), the brain (encephalitis), the spinal cord (myelitis), spinal roots (radiculitis), or a combination of sites (meningoencephalitis, encephalomyelitis, or myeloradiculitis). HEV infections are more frequently associated with viral meningitis, but infrequently associated with encephalitis. In aseptic meningitis, there is clinical and laboratory evidence for meningeal inflammation, with negative bacterial culture. The etiologies of aseptic meningitis include viruses (enteroviruses, herpes simplex virus, human immunodeficiency virus, West Nile virus, varicella-zoster virus, mumps, and lymphocytic choriomeningitis virus), bacterial infections (mycobacteria, spirochetes), parameningeal infections, brain abscess, medications, and malignancy. The clinical symptoms of aseptic meningitis are similar to those of bacterial meningitis: fever that ranges from 38°C to 40°C, headache, no change in mental status, no seizures, stiff neck, photophobia, occasionally anorexia, nausea, and vomiting. Over 90% of aseptic meningitis cases in infants are due to HEV, and the most common symptoms are fever and irritability. The outbreaks of meningitis are caused by certain serotypes of HEV-B species: coxsackievirus B5, echoviruses 6, 9, 30, whereas coxsackievirus A9, B3, and B4 are mostly endemic (Lee and Davies 2007). The children recover completely within 3 to 7 days of onset, but symptoms often persist in adults for longer (Rotbart et al. 1998).
Stroke
Jahangir Moini, Matthew Adams, Anthony LoGalbo in Complications of Diabetes Mellitus, 2022
With subarachnoid hemorrhage, the patient’s headache is usually extreme and peaks within a few seconds. He or she may lose consciousness. This is usually immediate, but can occur after several hours. Extreme neurologic deficits may occur, becoming irreversible in minutes to several hours. Sensory function may be impaired. The patient may become very restless, and seizures can occur. Unless there is herniation of the cerebellar tonsils, the patient’s neck is usually not stiff. Even so, aseptic meningitis causes moderate to severe meningismus within 1 day. There is usually vomiting and occasionally bilateral extensor plantar responses. There are often abnormalities of the heart or respiratory rates. During the first 5–10 days, continuing headaches, confusion, and fever are often seen. If there is secondary hydrocephalus, the patient may experience additional headache, motor deficits, and obtundation over weeks. If another bleed occurs, symptoms can recur, or new ones can emerge.
Leptospira
Dongyou Liu in Handbook of Foodborne Diseases, 2018
The immune phase of illness generally lasts from 4 to 30 days. During this phase, the host immune response tries to clear the leptospires from the body. However, they may get settled in the renal tubules and are shed in the urine for several days. The organisms can be detected in almost all tissues and organs during this phase. The immune phase along with symptoms of acute phase may be characterized by any or all of the following signs and symptoms: jaundice, renal failure, cardiac arrhythmias, pulmonary symptoms, aseptic meningitis, conjunctival suffusion with or without hemorrhage, photophobia, eye pain, muscle tenderness, adenopathy, and hepatosplenomegaly. Aseptic meningitis, with or without symptoms, is characteristic of the immune phase of illness, occurring in up to 80% of cases [6].
Neuro-ophthalmic Complications of Immune-Checkpoint Inhibitors
Published in Seminars in Ophthalmology, 2021
Loulwah Mukharesh, Bart K Chwalisz
Aseptic meningitis may present with headaches, fevers, neck stiffness, nausea, vomiting, and photophobia. Neuro-ophthalmic manifestations may include papilledema and pseudo-abducens palsy as sequelae of increased intracranial pressure. Notably, patients’ level of consciousness should be preserved in meningitis, in distinction to encephalitis or meningoencephalitis. Evaluations of these patients require a lumbar puncture to measure opening pressure, confirm inflammation and exclude an infectious etiology.19 Additional investigations should include MRI brain with and without contrast to evaluate for leptomeningeal/pachymeningeal enhancement and other CNS etiologies such as abscesses, encephalitis, demyelination, vasculitis, or metastasis. The onset of aseptic meningitis secondary to ICIs is variable, occurring either after 2–3 cycles20 of ICI or up to 14 cycles,21 and classically have normal neuroimaging.22 Treatment of one case of pembrolizumab-induced aseptic meningitis with intravenous corticosteroids resulted in clinical improvement.19
An Atypical Case of Enterovirus Meningitis Presenting with Unilateral Optic Disc Swelling and Minimal Optical Symptoms
Published in Ocular Immunology and Inflammation, 2023
Efthymios Karmiris, Georgios Vasilakos, Konstantinos Tsiripidis, Evangelia Chalkiadaki
Aseptic meningitis is defined as an acute infectious disease with CSF negative for bacteria and is most frequently due to a viral infection. Viruses are often overlooked as their sequelae are not as severe as bacterial meningitis or viral encephalitis, with the most common clinical symptoms for aseptic meningitis patients being fever, vomiting, headache and nausea. Viruses may reach the meninges from the bloodstream or be reactivated from a dormant state within the nervous system.7 Herpes-, arbo- and enteroviruses are the major etiologic agents of central nervous system infections, however their causative role among adult cases of aseptic meningitis is unclear.8 They preferentially cause harm in the very young9 and children are the primary victims of central nervous system infections due to enteroviruses. Therefore, little is known about the natural history of enterovirus meningitis in adults.6
Neuropsychiatric manifestations in primary Sjogren syndrome
Published in Expert Review of Clinical Immunology, 2022
Simone Appenzeller, Samuel de Oliveira Andrade, Mariana Freschi Bombini, Samara Rosa Sepresse, Fabiano Reis, Marcondes C. França
The prevalence of aseptic meningitis is difficult to establish, because most cases derive from case reports or case series [39]. In the majority of the reports, aseptic meningitis occurred in patients prior to pSS diagnosis [39]. Presenting symptoms were similar to those of idiopathic aseptic meningitis or aseptic meningitis associated with other diseases, with headache, fever, nausea or vomiting, and disturbance of consciousness as predominant features [39]. Of interest is the diagnosis of pSS concomitant with aseptic meningitis. Reports have described the occurrence of xerophthalmia and xerostomia (36%), parotitis (18%), arthritis (15%), and peripheral neuropathy (3%), highlighting the importance of careful clinical investigation [39]. Immunological findings have also been reported, with antinuclear antibodies occurring in 79% of patients, positive anti-Ro/SSA in 79%, and anti-La/SSB in 70% [39]. The majority of the patients (89%) required immunosuppressive treatment and recurrence was observed in 36% of the reports, with a median relapse rate of 2.9 , and an average of 35 month follow-up period [39]. Brain magnetic resonance imaging (MRI) findings are variable. Studies have described findings ranging from normal MRI to the presence of T2 weighted hyperintense inflammatory lesions in the cerebral white matter or cortex and vasculitis [25].