Disease Description (Causes and Symptoms)
- Definition: A condition in which inflammation develops in the brain and the meninges surrounding it due to a viral infection. It is commonly called aseptic meningitis.
- Main causes: In children, enteroviruses (including coxsackieviruses and echoviruses) account for more than 90% of cases. Other possible causes include herpesviruses (HSV), mumps virus (paramyxovirus), and varicella-zoster virus.
- Pathophysiology: The virus reaches the central nervous system through the bloodstream or neural pathways, causing inflammation of the meninges and sometimes the brain parenchyma. If the brain parenchyma is involved, symptoms of encephalitis may accompany it, and the prognosis may be worse.
- Common symptoms: Fever, severe headache, neck stiffness, photophobia, nausea, and vomiting. When the brain parenchyma is involved, altered consciousness, personality changes, seizures (epilepsy), or focal neurological deficits may occur. In children, it may present with a combination of nonspecific symptoms such as lethargy, feeding difficulty, excessive sleepiness, or excessive irritability.
Treatment Methods and Precautions
- Basic principles: Most cases of viral meningitis improve with symptomatic treatment (fluids and electrolyte correction, antipyretics, and pain control).
- Antiviral medication: If a herpesvirus such as HSV or VZV is suspected, or if there is brain parenchymal involvement (signs of encephalitis), intravenous acyclovir should be administered immediately. Specific antiviral medications for enteroviruses are limited and are usually unnecessary.
- Hospitalization and monitoring: Hospitalization and close observation are necessary for neonates and infants, decreased consciousness, persistent fever, tachycardia, hypotension, seizures, respiratory failure, or neurological abnormalities. If seizures occur, anticonvulsants should be administered and necessary medical care provided.
- Diagnosis-based treatment: Because bacterial infection cannot be ruled out initially, empiric antibiotics may be started depending on the clinical severity (especially in severely ill patients or young infants). Antibiotics are discontinued or adjusted according to the cerebrospinal fluid examination and blood culture results.
- Other medications and procedures: If increased intracranial pressure is suspected, appropriate treatment should be provided after imaging (CT/MRI). Steroids are generally not recommended for viral meningitis (they have indications in cases of tuberculous or bacterial meningitis).
- Precautions (including self-care): Get sufficient rest and fluids, control fever and headache, secure the airway during a seizure, and immediately visit an emergency medical facility. More active monitoring is necessary for high-risk groups such as immunocompromised people, neonates, and older adults.
Checklist Before an Outpatient Visit (Including Preparation Items and Example Questions)
- Items to bring:
- A list of currently taken medications, including prescription drugs, OTC medications, and supplements
- A record of when recent symptoms began and how they have changed (the start date and pattern of fever, characteristics of the headache, whether vomiting or seizures occurred, etc.)
- Medical history: chronic conditions (immunosuppression, diabetes, liver or kidney disease, etc.), recent surgery or trauma, and vaccination history (chickenpox, mumps, etc.)
- Previous test results (copies of blood tests, imaging tests, and previous cerebrospinal fluid test results, if available)
- For children: records of feeding amounts, urine output, and changes in sleep patterns
- Examples of materials to show the doctor during the outpatient visit:
- A fever diary (times and values of temperature measurements); if seizures have occurred, a video of the seizure or a detailed description
- Information about drug allergies
General Example Questions to Ask the Doctor
- How can you determine with certainty whether these symptoms are viral or bacterial? What additional tests are needed?
- What treatment (medication) do you recommend now, and what side effects can be expected?
- What signs indicate that hospitalization or emergency treatment is needed? When should we go to the hospital immediately?
- What is the average time to recovery, and what is the follow-up plan?
- How likely are complications or sequelae (cognitive impairment, epilepsy, etc.), and what should be done to prevent or monitor them?
Examples of Disease-Specific Questions
- (For neonates/infants) Our child needs a cerebrospinal fluid puncture (lumbar puncture). What are the risks, and what precautions should be taken before and after the test?
- (During testing) If the enterovirus PCR result is negative in blood and cerebrospinal fluid tests, can viral meningitis be ruled out? What additional tests are needed?
Additional Reference (Brief Summary)
- Symptoms requiring an emergency hospital visit: severe decrease in consciousness, persistent seizures, difficulty breathing, rapid neurological deterioration, or rapid worsening of signs of meningeal irritation.
- Prevention: Hand hygiene is important to prevent the spread of enteroviruses; available vaccinations against viruses that commonly cause outbreaks (e.g., mumps and chickenpox) are recommended.
- Prognosis: In principle, most people with normal immune function improve within 7–10 days; however, the risk of complications and long-term sequelae is higher when the brain parenchyma is involved or in neonates and immunocompromised people.