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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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Topic Resources

Noninfectious meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space) when it is caused by disorders that are not infections or by drugs or vaccines.

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

Within the skull, the brain is covered by three layers of tissue called the meninges:

  • Dura mater (outer layer)

  • Arachnoid mater (middle layer)

  • Pia mater (inner layer)

Between the arachnoid membrane and pia mater is the subarachnoid space. This space contains cerebrospinal fluid, which flows through the meninges, fills the spaces within the brain, and helps cushion the brain and spinal cord.

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.

Table
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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

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

  • Spinal tap and analysis of cerebrospinal fluid

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

  • Treatment of the cause

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
No US brand name
Gammagard S/D
AZULFIDINE
TEGRETOL
CILOXAN, CIPRO
IMURAN
NEORAL, SANDIMMUNE
ZANTAC
LANIAZID
ZOVIRAX
ADVIL, MOTRIN IB
ALEVE, NAPROSYN
CLINORIL
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