School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
BMC Neurol. 2022 Sep 10;22(1):340. doi: 10.1186/s12883-022-02873-1.
Meningitis is known as a meningeal inflammation accompanied by pleocytosis in the cerebrospinal fluid (CSF), and can be classified into acute, subacute, and chronic meningitis based on symptoms duration of ≤ 5 days, ≥ 5 days and ≥ 4 weeks, respectively. Subacute and chronic meningitis are caused mainly by indolent infectious agents and noninfectious causes such as autoimmune, and neoplastic. In this study, we investigated the characteristics, diagnosis, and treatment of subacute and chronic meningitis.
We extracted the medical records of patients with chronic and subacute meningitis who were referred to three tertiary centers from Jun 2011 to Jun 2021. Initially, 2050 cases of meningitis were screened, and then 79 patients were included in the study.
Headache (87.3%), nausea and vomiting (74.7%), fever (56.4%), and visual impairments (55.7%) were the most prevalent symptoms. The most common signs were nuchal rigidity (45.3%), altered mental status (26.9%), and papillary edema (37.5%). Brain computed tomography (CT) was normal in 68.6% of the patients while 22.9% of the cases had hydrocephalus. Brain magnetic resonance imaging (MRI) was normal in 60.0% of the patients. The most common abnormal MRI findings were leptomeningeal enhancement (16.0%) and hydrocephalus (16.0%). We had a 44.3% definite diagnosis with bacterial (n:25, 31.6%) and neoplastic (n:8, 10.1%) being the most prevalent etiologies. Mycobacterium tuberculosis (60%) and Brucella spp. (12%) were the most prevalent bacterial pathogens.
The most common etiologies include infectious, neoplastic, and immunologic. Due to insidious presentation and uncommon etiologies, establishing a proper diagnosis, and providing timely targeted treatment for patients with subacute and chronic meningitis remains a challenge for clinicians.
脑膜炎是一种脑膜炎症，伴有脑脊液（CSF）中的白细胞增多，根据症状持续时间可分为急性、亚急性和慢性脑膜炎，分别为≤5 天、≥5 天和≥4 周。亚急性和慢性脑膜炎主要由慢性感染性病原体和非感染性原因引起，如自身免疫和肿瘤。在这项研究中，我们调查了亚急性和慢性脑膜炎的特征、诊断和治疗。
我们从 2011 年 6 月至 2021 年 6 月，从三个三级医院提取了慢性和亚急性脑膜炎患者的病历。最初筛选了 2050 例脑膜炎病例，然后纳入了 79 例患者进行研究。
头痛（87.3%）、恶心和呕吐（74.7%）、发热（56.4%）和视力障碍（55.7%）是最常见的症状。最常见的体征是颈项强直（45.3%）、意识改变（26.9%）和视乳头水肿（37.5%）。脑部计算机断层扫描（CT）正常的患者占 68.6%，而 22.9%的病例有脑积水。脑部磁共振成像（MRI）正常的患者占 60.0%。最常见的异常 MRI 表现是脑膜强化（16.0%）和脑积水（16.0%）。我们的明确诊断率为 44.3%，细菌（n=25，31.6%）和肿瘤（n=8，10.1%）是最常见的病因。结核分枝杆菌（60%）和布鲁氏菌属（12%）是最常见的细菌病原体。
最常见的病因包括感染、肿瘤和免疫。由于隐匿性表现和罕见的病因，为亚急性和慢性脑膜炎患者建立适当的诊断并提供及时的靶向治疗仍然是临床医生面临的挑战。
