Mollaret meningitis

Alternate names

Benign recurrent aseptic meningitis; Mollaret's meningitis; Benign recurrent lymphocytic meningitis; Recurrent meningitis

Definition

Mollaret meningitis is a type of meningitis due to a viral infection (aseptic meningitis) that occurs multiple times.

Cause

• The virus most commonly responsible for Mollaret meningitis is the herpes simplex virus (usually HSV-2, the type generally responsible for genital herpes, but also HSV-1).
• However, more than half of people with Mollaret meningitis due HSV-2 do not report a history of genital herpes.
• Epstein-Barr virus has also been associated with Mollaret meningitis.

Signs and symptoms

• Mollaret meningitis is characterized by recurrent episodes of viral meningitis.
• The episodes of meningitis usually last from two to five days and then go away on their own, but the time in between episodes varies among people with the disease, from weeks to years.
• Some people have milder symptoms during recurrences, which do not necessarily require hospitalization.

Symptoms during an episode commonly include:

• severe headache
• fever
• stiff neck
• nausea and vomiting
• sensitivity to light (photophobia) or sound
• feeling tired or unwell (malaise)
• muscle pain

Some people experience temporary neurological symptoms, such as:

• double vision (diplopia)
• hallucinations
• an altered mental state
• cranial nerve palsy
• seizures

Each recurrence of meningitis increases the risk for a person to develop permanent neurological problems or disability, which occur in about half of people with Mollaret meningitis.

Various long-term symptoms have been reported, including:

• cognitive impairment
• memory loss
• problems with balance and coordination
• hearing or vision problems
• ringing in the ears (tinnitus)
• speech problems
• epilepsy

Diagnosis

• The diagnosis typically involves detecting herpes simplex virus DNA in the cerebrospinal fluid, which is collected during a lumbar puncture (spinal tap).
• This test can diagnosis other types of meningitis as well.

Treatment

• Treatment may involve an antiviral drug such as acyclovir to treat and prevent recurrent episodes of viral meningitis, as well as various medications to treat specific symptoms present in each person.
• While antiviral drugs have reportedly improved symptoms in many cases, the effectiveness of antiviral therapy is difficult to measure due to the rarity of the disease and its recurrent and spontaneous nature.
• While aseptic meningitis usually is not fatal, serious complications such as encephalitis and coma can develop in severe cases.

NIH genetic and rare disease info

• NIH info on Mollaret meningitis

Mollaret meningitis is a rare disease.

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