A young male develops fever, followed by headache, confusional state, focal seizures and right hemiparesis. The MRI performed shows bilateral frontotemporal hyper intense lesion. The most likely diagnosis is: (AI 09)
|A||Acute pyogenic meningitis|
|B||Herpes simplex encephalitis|
Herpes simplex encephalitis
Chronic Meningitis (Ref. Hari- 18th ed., pg- 3435)
1). Chronic inflammation of the meninges can produce profound neurologic disability and may be fatal if not successfully treated.
2). The condition is most commonly diagnosed when a characteristic neurologic syndrome exists for >4 weeks and is associated with a persistent inflammatory response in the CSF (white blood cell count >5/ L).
3). The causes are varied, and appropriate treatment depends on identification of the etiology.
4). Five categories of disease account for most cases of chronic meningitis:
a. Meningeal infections,
c. Noninfectious inflammatory disorders,
d. Chemical meningitis
e. Parameningeal infections.
f. v. Spread from the subarachnoid space into brain parenchyma may occur via the arachnoid cuffs that surround blood vessels that penetrate brain tissue (Virchow-Robin spaces).