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Noninfectious Meningitis

By

John E. Greenlee

, MD, University of Utah School of Medicine

Last full review/revision Aug 2019| Content last modified Aug 2019
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Meningitis is occasionally caused by noninfectious conditions (eg, noninfectious disorders, drugs, vaccines). Many cases of noninfectious meningitis are subacute or chronic.

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Some Noninfectious Causes of Meningitis

Type

Examples

Disorders

Metastatic cancer

Rupture of an intracranial cysticercal or epidermoid cyst

Drugs with anti-inflammatory or immune-modulating effects

Azathioprine

Cyclosporine

Cytosine arabinoside

IV immune globulin

Nonsteroidal anti-inflammatory drugs (most commonly, ibuprofen)

Other drugs

Certain antibiotics (eg, ciprofloxacin, isoniazid, penicillin, trimethoprim/sulfamethoxazole)

Carbamazepine

Phenazopyridine

Ranitidine

Substances injected into the subarachnoid space

Anesthetics

Antibiotics

Chemotherapy drugs

Radiopaque contrast agents

Symptoms of noninfectious meningitis are similar to those caused by other kinds of meningitis (eg, headache, fever, nuchal rigidity). Severity and acuity can vary, but noninfectious meningitis tends to be less severe than acute bacterial meningitis.

Diagnosis of noninfectious meningitis is based on analysis of cerebrospinal fluid (CSF) obtained by lumbar puncture (preceded by neuroimaging if increased intracranial pressure or an intracranial mass effect is suspected). CSF findings may include

  • Lymphocytic or neutrophilic pleocytosis

  • Elevated protein

  • Usually normal glucose

Treatment of noninfectious meningitis involves treating causative disorders and stopping causative drugs. Otherwise, treatment is supportive.

If patients appear seriously ill, appropriate antibiotics and corticosteroids are started immediately (without waiting for tests results) and continued until acute bacterial meningitis is ruled out (ie, CSF is shown to be sterile).

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NOTE: This is the Professional Version. CONSUMERS: Click here for the Consumer Version
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