neurologic disorders
Viral Meningitis
Diagnosis of Viral Meningitis
Cerebrospinal fluid (CSF) analysis (cell count, protein, glucose) Polymerase chain reaction (PCR) of CSF and sometimes IgM Sometimes PCR and/or culture of blood, a throat swab, nasopharyngeal secretions, or stool Diagnosis of viral meningitis is based on analysis of CSF obtained by Lumbar puncture (preceded by neuroimaging if increased intracranial pressure or a mass is suspected). Typically, protein is slightly increased but less than that in acute bacterial meningitis (eg, < 150 mg/dL); however, the protein level can be very high in CSF viral culture is insensitive and not routinely done. PCR can be used to detect some viruses in CSF ( Overview of Enterovirus Infections and Patients with HSV-2 meningitis may have enlarged mononuclear cells (Mollaret cells) in the CSF. HSV-2 meningitis often recurs (called Recurrent viral meningitis . Viral serologic tests, PCR, or culture of samples taken from other areas (eg, blood, a throat swab, nasopharyngeal secretions, stool) may help identify the causative virus. If patients appear seriously ill, treat them for acute bacterial meningitis until it is ruled out, even if the cause is suspected to be viral. 