Meningitis differential diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]

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Differential Diagnosis
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Differentiating Meningitis from other Diseases

• Brain abscess - Brain abscess is a focal infection of the brain parenchyma commonly caused by bacteria, fungal and parasitic pathogens. Imaging and neurosurgical aspiration is required for differentiation in addition to CSF profile.

• Encephalitis - Encephalitis is the inflammation of brain. Meningitis can itself cause encephalitis and is called meningoencephalitis. The symptoms appear gradually in encephalitis but occur abruptly in meningitis.

• Delirium tremens - Delirium tremens and alcohol withdrawal should be differentiated from meningitis especially when present with confusion and fever. Both the conditions can coexist.

• Brain tumor - Brain tumors can simulate purulent meningitis with symptoms of fever, signs of meningeal irritation and marked CSF pleocytosis. Irritation of leptomeninges by tumor and its breakdown products causes these symptoms. Determination of creatine kinase BB and carcinoembryonic antigenhelps in differentiating.

• Subarachnoid hemorrhage - Subarachnoid hemorrhage also presents with severe headache, neck stiffness, nausea and vomiting like meningitis. It is a medical emergency. Imaging studies help in differentiation. Tubercular meningitis should be considered in the differential diagnosis in cases of nonaneurysmal subarachnoid hemorrhage.