Mollaret's meningitis

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Mollaret's meningitis
File:Meninges-en.svg
Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Recurrent episodes of aseptic meningitis, fever, headache, neck stiffness, photophobia
Complications	Rarely, seizures or neurological deficits
Onset	Typically in adulthood
Duration	Episodes last 2-5 days, with symptom-free intervals
Types	N/A
Causes	Often associated with Herpes simplex virus (HSV-2)
Risks	History of HSV infection
Diagnosis	Lumbar puncture, PCR testing for HSV
Differential diagnosis	Bacterial meningitis, viral meningitis, autoimmune meningitis
Prevention	N/A
Treatment	Supportive care, antiviral therapy in some cases
Medication	N/A
Prognosis	Generally good, with episodes resolving spontaneously
Frequency	Rare
Deaths	N/A

File:PCR tests of Mollaret's Meningitis patient from Kojima et al, 2002.jpg

PCR tests of Mollaret's Meningitis patient

Other Names: Benign recurrent aseptic meningitis; Mollaret's meningitis; Benign recurrent lymphocytic meningitis

Pathophysiology

Mollaret meningitis is a type of meningitis due to a viral infection (aseptic meningitis) that occurs multiple times. It is characterized by repeated episodes of meningitis, typically lasting two to five days, occurring weeks to years apart. Common signs and symptoms during an episode may include severe headache, fever, nausea, vomiting, sensitivity to light (photophobia), and stiff neck. Some people also experience temporary neurological symptoms such as double vision, hallucinations, altered consciousness, cranial nerve palsy, or seizures. Almost half of people with Mollaret meningitis develop long-term neurological impairment such as problems with memory, balance, coordination, and/or hearing.

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.

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 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.

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 status
• 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 loss or vision problems
• ringing in the ears (tinnitus)
• speech problems
• epilepsy

NIH genetic and rare disease info

• NIH info on Mollaret's meningitis

Mollaret's meningitis is a rare disease.