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Last reviewed: 19 Mar 2025
Last updated: 18 Feb 2025

Summary

Definition

History and exam

Key diagnostic factors

  • headache
  • nausea and vomiting
  • photophobia
  • neck stiffness
  • fever

Other diagnostic factors

  • rash
  • Kernig sign
  • Brudzinski sign

Risk factors

  • infants and young children
  • young adults
  • older people
  • summer and fall
  • exposure to mosquito or tick vector
  • unvaccinated for mumps
  • use of swimming pools and ponds
  • immunosuppression
  • exposure to rodents

Diagnostic tests

1st tests to order

  • CSF microscopy
  • CSF Gram stain
  • CSF bacterial culture
  • CSF protein
  • CSF glucose
  • CSF PCR for enteroviruses
  • CSF PCR for herpes viruses
  • HIV serology/HIV reverse transcriptase (RT)-PCR

Tests to consider

  • CT/MRI head
  • EEG
  • CSF viral culture

Emerging tests

  • CSF C-reactive protein (CRP)
  • serum and CSF procalcitonin
  • CSF lactate

Treatment algorithm

Contributors

Expert advisers

John Williams, MRCP, DTM&H

Consultant

The James Cook University Hospital

Middlesbrough

UK

Disclosures

JW declares that he has no competing interests.

Acknowledgements

Dr John Williams would like to gratefully acknowledge Dr David Chadwick, a previous contributor to this topic.

Disclosures

DC is an author of a reference cited in this topic.

Peer reviewers

Karen Roos, MD

John and Nancy Nelson Professor of Neurology

Indiana University School of Medicine

Indianapolis

IN

Disclosures

KR declares that she has no competing interests.

Vassiliki Syriopoulou, MD

Professor of Pediatrics

University of Athens

Aghia Sophia Children's Hospital

Athens

Greece

Disclosures

VS declares that she has no competing interests.

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