Table 4.
Highlights the features of aseptic meningitis secondary to viral etiology and neuro-sarcoidosis associated meningitis.
| Sarcoidosis | Multiple sclerosis | Aseptic meningitis associated with viral infection | |
|---|---|---|---|
| Laboratory | Elevated ACE level Abnormal calcium metabolism (hypercalciuria and/or hypercalcemia) (7, 12) |
Non-specific laboratory findings | Enteroviruses most common, arboviruses, herpesviruses, influenza, mumps, HIV (109, 116, 117). |
| Eye involvement | Anterior uveitis Acute Bilateral optic neuritis (118, 119) |
Unilateral optic neuritis, pain on eye movement, partial and mainly central visual blurring, normal disc or mild disc swelling | Ocular involvement not common. |
| Myelopathy | Can progress to spastic paraparesis MRI spine-meningeal and nerve root involvement (120) |
Can progress to spastic paraparesis MRI spine-no meningeal enhancement has been reported. |
Myelopathy is not common. |
| CSF findings | Lymphocytic Pleocytosis (57–72% patients) Elevated Protein (50–70% patients) Low glucose (18% patients) CSF ACE elevated 50% patients Oligoclonal bands Elevated CSF pressure finding of Kveim specific IgG in CSF (89, 121, 122) |
Mild Lymphocytic Pleocytosis (<50/mm3) Protein may be elevated in 1/3 cases. Normal glucose and pressure (123, 124) Oligoclonal bands or elevated IgG index in CSF (125) |
Mononuclear pleocytosis (may be neutrophilic in early stage) Protein concentration can be normal to elevated (typically 0.4–0.8 g/l). Normal to low glucose CSF PCR specific for virus (enterovirus, HSV, VZV) (109) |
| MRI findings | Variable contrast enhancement of the leptomeninges with a nodular or diffuse pattern, non-specific white matter lesions, and hydrocephalus. | Oval, asymmetric white matter lesions perpendicular to the ventricles (Dawson fingers) or in the periventricular, juxtacortical, infratentorial or spinal cord region, and having a diameter >6 mm are considered typical of MS (54, 126–129) | MRI demonstrates abnormalities specific to the viral etiological agent (107) |
| Treatment | Corticosteroids | Corticosteroids, DMDs | Supportive management Acyclovir in HSV |
CSF, Cerebrospinal fluid; MRI, Magnetic resonance imaging; PCR, Polymerase chain reaction; DMDs, Disease-modifying drugs; ACE, Angiotensin converting enzyme; MRI, magnetic resonance imaging.