Diagnosis of Viral Meningitis

A. Laboratory Studies
1. Hematology and chemistry tests should be performed
2. Examination of CSF is an important examination in the examination of the causes of meningitis. CT scans should be performed in cases related to abnormal neurological signs to exclude intracranial lesions or obstructive hydrocephalus before lumbar puncture (LP). CSF culture remains the criterion standard examination piogen of bacterial or aseptic meningitis. Again, patients who handled the majority of bacterial meningitis can occur with gram-negative staining and then the resulting aseptic. The following is a characteristic CSF is used to support the diagnosis of viral meningitis:

     a. Cells: pleocytosis with WBC count in the range of 50 to> 1000 x 109 / L blood has been reported in viral meningitis, predominantly mononuclear cells is the rule, but it can PMN are the main cells in the first 12-24 hours; then the cell count is usually dominated by the pole CSF lymphocytes classic viral meningitis. This helps to distinguish bacterial from viral meningitis, which has a higher cell count and PMN predominant cell differences in the cell; this is not an absolute Atran however.
      b. Protein: The protein content of the CSF is usually slightly increased, but may vary from normal to as high as 200 mg / dL.
3. Procedure
- Lumbar puncture is an important procedure used in the diagnosis of viral meningitis. Another potential procedures, depending on the individual and the severity of disease indications, including monitoring of intracranial pressure, brain biopsy, and ventricular drainage or shunting.
4. Histological
- Because of the low mortality rate with acute viral meningitis, other pathologic features compared with lymphocytic response in the CSF is generally not a proof. Leptomeningea that there is inflammation with PMN and mononuclear cells in the acute phase of the disease. neuronophagia, and an increase in the number of microglia cells was noted in specimens from patients who died of sejumplah encephalitis virus.
B.  Imaging Studies
1. Imaging for suspicion of viral meningitis and encephalitis can include head CT with and without contrast, or MRI of the brain with gadolinium.
2. CT scan with contrast helps in getting rid of intracranial pathology. Contrast scan should be obtained to evaluate for the addition and to get rid of all the mening cerebritis, intracranial abscess, subdural empyema, another or lesion. Alternatively, and if available, brain MRI with gadolinium can be performed.
3. MRI with contrast is a standard criterion to visualize intracranial pathology in viral encephalitis. HSV-1 typically affects the basal frontal and temporal lobes with an overview of bilateral lesions often diffuse.

C. Other Tests
a. All patients whose condition did not improve clinically within 24-48 hours of work plans should be made to determine the cause of meningitis.
b. In the case of suspected encephalitis, MRI with increased contrast and adequate visualization of the basal frontal and temporal areas is required.
c. EEG can be performed if the suspected encephalitis or subclinical seizures in patients who are impaired, Periodic lateralized epileptiform discharges (PLEDs) are often seen in herpetic encephalitis.

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