Department of Neurology, Geisinger Commonwealth School of Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822, USA.
Department of Neurology, Geisinger Commonwealth School of Medicine, Geisinger Medical Center, 100 North Academy Avenue, Danville, PA 17822, USA.
Neurol Clin. 2018 Nov;36(4):831-849. doi: 10.1016/j.ncl.2018.06.004. Epub 2018 Sep 20.
Chronic meningitis is defined as cerebrospinal fluid pleocytosis that persists for at least 4 weeks without spontaneous resolution. The differential diagnosis of chronic meningitis is broad, encompassing 4 main categories, including infectious, autoimmune, neoplastic, and idiopathic. Up to one-third of cases have no discernible cause, making chronic meningitis a diagnostic dilemma for many clinicians. This article suggests a diagnostic approach to chronic meningitis using clinical history, key examination findings, selective advanced testing, and neuroimaging. Case presentations demonstrate application of a diagnostic algorithm, followed by a brief discussion on common infectious pathogens, autoimmune conditions, and neoplastic disease with selected treatment regimens.
慢性脑膜炎定义为脑脊液白细胞增多持续至少 4 周而无自发缓解。慢性脑膜炎的鉴别诊断范围广泛，包括感染性、自身免疫性、肿瘤性和特发性疾病 4 大类。多达三分之一的病例没有明显的病因，这使得慢性脑膜炎成为许多临床医生面临的诊断难题。本文采用临床病史、关键检查结果、选择性高级检查和神经影像学等方法，提出了一种慢性脑膜炎的诊断方法。病例介绍展示了诊断算法的应用，然后简要讨论了常见的感染性病原体、自身免疫性疾病和肿瘤性疾病，并选择了治疗方案。
