Chronic Meningitis

Chronic meningitis is chronic inflammation of the meninges with characteristic neurological syndromes, lasting more than 4 weeks, and associated with persistent inflammatory response (CSF pleocytosis). It may present by meningoencephalitis, meningomyeloradicalitis, cranial nerve palsy, optico-chiasmatic arachnoiditis, meningovascular syndromes and hydrocephalus as isolated, or combined forms. Etiologic causes include infectious (bacterial (TB, Brucella, syphilis), viral, fungal, protozoal and helminthic), neoplastic (carcinomas, lymphomas, leukemias, primary CNS tumors, etc.), chemical, drug induced, vasculitic and granulomatous disorders (SLE, Behcet''s syndrome, primary CNS angitis, sarcoidosis, etc.). Approach to these patients includes epidemiological features, assessment of associated involved organs (e. g., mucocutaneous system, eye, lymph nodes, liver and spleen, pulmonary tract, etc.), CSF studies (including microbiologic, immunologic, cytologic, etc.), Imaging studies, leptomeningial biopsy and finally empirical therapy.