Noninfectious Meningitis
(See also Introduction to Meningitis.)
The brain and spinal cord are covered by three layers of tissue called meninges. The subarachnoid space is located between the middle layer and the inner layer of the meninges. This space contains the cerebrospinal fluid, which flows through the meninges, fills the spaces within the brain, and helps cushion the brain and spinal cord.
Noninfectious meningitis is a type of aseptic meningitis (meningitis caused by something other than the bacteria that typically cause acute meningitis).
Tissues Covering the Brain
Causes
Noninfectious meningitis is caused by disorders that are not infections or by drugs or vaccines. Overall, these conditions are uncommon causes of meningitis.
Disorders that most commonly cause noninfectious meningitis include disorders that cause inflammation, such as the inflammation that occurs when the body's immune system malfunctions and attacks the body's own tissues (autoimmune disorders). Such disorders include rheumatoid arthritis and systemic lupus erythematosus (lupus).
Drugs that can cause noninfectious meningitis include nonsteroidal anti-inflammatory drugs (NSAIDs) and certain antibiotics. Noninfectious meningitis due to NSAIDs may occur in people who have autoimmune disorders such as rheumatoid arthritis or systemic lupus erythematosus (lupus).
Noninfectious meningitis may also develop after a brain cyst ruptures and the fluid in it leaks into the subarachnoid space. Such cysts may be present at birth or be caused by a tapeworm infection called cysticercosis.
Some Causes of Noninfectious Meningitis
Type |
Examples |
|
Disorders |
Cancer that has spread to the brain from other parts of the body (as can occur in leukemia, lymphoma, melanoma, or breast or lung cancer) Rupture of a brain cyst Systemic lupus erythematosus (lupus) |
|
Drugs that suppress the immune system (used to treat autoimmune disorders and inflammation or to prevent rejection of a transplanted organ) |
Azathioprine Cyclosporine Cytosine arabinoside Immune globulin given by vein (intravenously) Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, naproxen, sulindac, and tolmetin |
|
Other drugs |
Certain antibiotics, such as ciprofloxacin, isoniazid, and penicillin Carbamazepine (an antiseizure drug) Phenazopyridine (used to treat urinary symptoms) Ranitidine* (used to treat stomach ulcers) Sulfa drugs, such as trimethoprim-sulfamethoxazole (an antibiotic) and sulfasalazine (used to treat ulcerative colitis) |
|
Substances that are injected into the subarachnoid space† for treatment or diagnosis |
Anesthetics Antibiotics Chemotherapy drugs Radiopaque contrast agents used in imaging tests |
|
* Ranitidine (taken by mouth, intravenously, and over the counter) has been removed from the market in the United States and in many other countries because of unacceptable levels of N-nitrosodimethylamine (NDMA), which is a substance that probably causes cancer. |
|
|
† The subarachnoid space contains cerebrospinal fluid and is located between middle and inner layers of tissue that cover the brain and spinal cord (meninges). |
|
Symptoms
Usually, noninfectious meningitis causes symptoms that are similar to those of bacterial meningitis but are milder and may develop more slowly. Symptoms include headache, a stiff neck, and often fever. When the neck becomes stiff, lowering the chin to chest becomes painful.
Most people recover in 1 to 2 weeks.
Diagnosis
Doctors suspect meningitis when people have a headache and stiff neck, particularly with fever. They then try to determine whether meningitis is bacterial (requiring immediate treatment) or not. If the symptoms are less severe, the cause is less likely to be bacteria.
A spinal tap (lumbar puncture) is done to obtain a sample of cerebrospinal fluid. Computed tomography (CT) or magnetic resonance imaging (MRI) is done first if doctors suspect that pressure within the skull is increased or that a brain cyst or other mass in the brain is the cause. In such cases, doing a spinal tap may cause a life-threatening disorder called brain herniation. After pressure within the skull is lowered or if no mass is detected, the spinal tap is done.
The sample of cerebrospinal fluid is sent to a laboratory to be examined and analyzed. Sugar and protein levels and the number and type of white blood cells in the fluid are determined. The fluid is cultured to check for bacteria and thus rule out or confirm bacterial meningitis. Noninfectious meningitis is possible when the fluid contains excess white blood cells (indicating inflammation) and does not contain any bacteria that could be the cause. Then other tests are done to identify infectious organisms other than bacteria, such as viruses and fungi in the cerebrospinal fluid.
Noninfectious meningitis is likely if people have a disorder or take a drug that can cause meningitis and the person's symptoms and test results do not suggest that the cause is an infection.
Treatment
If people appear very ill, doctors start treatment right away without waiting for test results to identify the cause. Treatment includes antibiotics, which are given until doctors are sure that these people do not have bacterial meningitis, which, if untreated, can quickly cause permanent brain damage or death. They are also given acyclovir (an antiviral drug) in case the infection is due to herpes simplex virus.
After the cause is identified, doctors treat the cause accordingly—for example, by treating a disorder or stopping a drug. Symptoms are treated as needed.
Drugs Mentioned In This Article
| Generic Name | Select Brand Names |
|---|---|
Phenazopyridine |
No US brand name |
Immune globulin |
Gammagard S/D |
sulfasalazine |
AZULFIDINE |
Carbamazepine |
TEGRETOL |
ciprofloxacin |
CILOXAN, CIPRO |
Azathioprine |
IMURAN |
Cyclosporine |
NEORAL, SANDIMMUNE |
Ranitidine |
ZANTAC |
isoniazid |
LANIAZID |
acyclovir |
ZOVIRAX |
ibuprofen |
ADVIL, MOTRIN IB |
naproxen |
ALEVE, NAPROSYN |
sulindac |
CLINORIL |
