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Viral meningitis and papilledema

Case contributed by Assoc Prof Frank Gaillard


Headache and decreased vision.

Patient Data

Age: 30 years
Gender: Female

MRI Brain (infection protocol)

MRI of the brain demonstrates prominent sulcal high T2 signal on post Gad FLAIR and much less florid leptomeningeal enhancement. Prominent papilledema is visible, best seen on thin T2. Otherwise the study is unremarkable. 

Case Discussion

The patient went on to have a lumbar puncture. 

Cerebrospinal fluid

  • CSF Protein 2.99 g/L  (Normal <0.45)
  • CSF Glucose  6.1H mmol/L (Normal  2.2 - 3.9)
  • CELL COUNT: x10^6/L
    • Erythrocytes 294
    • Polymorphs 35
    • Lymphocytes 180
  • BACTERIAL CULTURE No growth after 6 days

  • FUNGAL CULTURE : No growth after 14 days

  • CRYPTOCOCCAL SEROLOGY (CSF and Serum): Cryptococcal Ag: NOT Detected 


    • DNA Amplification Assay for M.tuberculosis Complex(PCR): Negative

    • CULTURE SCREEN: MGIT bottle:  Negative


MACROSCOPIC APPEARANCE: CSF Total volume: 10.0 ml(s), Slightly cloudy

MICROSCOPIC DESCRIPTION: The smears contain abundant lymphocytes with some monocytes. The lymphoid cells show no nuclear atypia. No increased numbers of neutrophils or eosinophils are seen. No organisms are present. No malignant cells are identified. Auramine-Rhodamine Stain: No Acid Fast Bacilli Detected (A negative acid-fast smear result does not exclude the presence of mycobacterium species.)

FINAL DIAGNOSIS: Chronic inflammation. No evidence of malignancy.



Features are consistent with viral meningitis. The patient gradually recovered with only supportive measures. 

Post contrast FLAIR is very helpful in identifying any condition with leptomeningeal vessel leakiness. It is therefore helpful in meningitis and leptomeningeal carcinomatosis. 

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Case information

rID: 38266
Published: 18th Feb 2016
Last edited: 9th Aug 2020
Inclusion in quiz mode: Included

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