Aseptic meningitis - ultrasound

Case contributed by Yaïr Glick
Diagnosis almost certain


Source of fever?

Patient Data

Age: 3 months
Gender: Male

Smooth hyperechoic meninges, most compatible with aseptic meningitis.
No focal lesions in the demonstrable brain tissue.
Widened extra-axial compartment, in keeping with benign enlargement of subarachnoid spaces (BESS).

Case Discussion

Presented with fever 1 day after circumcision, which was carried out at the age of 3 months (instead of 8 days), as he was born prematurely at week 29, weighing only 850 grams.

Urine culture was sterile. Lumbar puncture was performed and the infant was started on intravenous ceftriaxone. CSF glucose and lactate were within the normal range and BioFire® results for a long list of bacteria and viruses came back negative.

Head ultrasound was performed which showed hyperechoic meninges, highly suggestive of aseptic meningitis.

The differential diagnosis for hyperechoic meninges includes

  • bacterial meningitis: meningeal thickening and hyperemia
  • subarachnoid blood from the LP: highly unlikely that the puncture could amount to so much blood as to cover the meninges

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