Chronic Meningitis

There are no pathognomonic features of chronic meningitis. The classic symptoms, if present, may be extremely subtle and variable. There may be unusual symptoms such as psychoses, movement disorders, and parkinsonian syndrome. The average duration of symptoms is 17 to 43 months, during which symptoms may fluctuate or remain static. CSF that shows a mildly decreased glucose level in the setting of mononuclear pleocytosis should always raise the suspicion of chronic meningitis. The causes are numerous, and attention should be paid to a history of previous systemic diseases, specific infections that could involve the meninges, possible exposures, geographic risk factors, immunologic compromise, and concurrent extraneural involvement (Boxes 42-9 and 42-10).

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