Question Title: Possible Mollaret's Meningitis

Forum: Neurology Forum
Topic: Meningitis

To tell you the truth, I hardly know where to begin but back in June of '98 I was hospitalized with viral meningitis. There where wbc's found in the csf and my protein and glucose csf levels were 'off'. They were able to culture out the virus which was an enterovirus. Most of what I had ever read about viral meningitis was that it was a self-limiting disease from which one usually has full recovery. Looking back I don't think I ever met the "normal" criteria. My vision has greatly changed - I went from not wearing any kind of a corrective lense to glasses that I actually notice how big the lenses are. I also cannot ride in a car for more than an hour - I begin to have spasms in the neck and upper back. But the most bothersome has been the headaches. Reoccurring headaches after the initial attack are not uncommon but I constantly have them. They seem to start at the base of the skull and move towards the front. To make a long story short here, if that's possible, back in November I had a horrible headache, my neck again was stiff and I had the nausea c/o the vomiting. I thought I was having a reoccurence for sure, the doctor thought this time that it was only cerival adenopathy. Gave me some cipro and synalgos dc, had to have my 2nd round of a ct scan and MRI and sent me on my way. So March rolls around and one night I can't go to bed because I'm vomiting. Finally do get to bed only to wake up with a 104.4 temp and the inability to move my neck and the headache from h__ll! Went to hospital, my pulse was >130 and BP was 80/50. They did all the routine tests - lumbar puncture, MRI, ct scan and the blood work. This time though no virus was found. Saw a neurologist in the hospital - he wanted to know when he pressed on my toes if he was pressing up or down?!?! I also saw an infectious disease specialist while I was there. He became almost 'giddy' like a small child with a new toy when I mentioned Nov.'s cervical adenopathy. He had my husband and mother leave the room so he could ask me how many sexual partners I've had and if I do IV drugs to see if I possibly had AIDS! Sorry to be long in explanation but I feel just like Jeff Dale who posted on Dec 15 '98. I don't think my primary care doc knows what's going on, the neurologist I saw I don't think he even had a clue and the infectious disease doc , as you can probably tell, quite offended me. I'm sitting here typing because it's April and once again I have a headache, extreme neck stiffness, and am very nausea. I've spoken with my primary care doc and he wondered if if wasn't mollaret's meningitis that I have. So far most of what I've read points to HSV 1 OR 2 being the cause. I've never had or am being treated for either. PLEASE offer some advice!! I am becoming very depressed - no one seems to know what's wrong with me but I'm still in extreme pain. I too have asked to see a pain specialist. I've been told though to take Indocin for the pain and flexeril for the stiff neck?!?! I'm about at my wits end - I'm only 29 and have always been pretty healthy - WHAT CAN I DO?????????????????

Dear Laura:

Sorry to hear about your problems. What you describe is a chronic meningitis. Yes, you could have Mollaret's or recurrent HSV-1. If this is what is thought to be occurring then acylovir is the treatment of choice. What we have found is that in at least of 1/3 of asceptic meningiditis the agent is not found. There are at least 5 categories of chronic asceptic meningitis, doubtful that you have 3 of them. So the other two are as follows. The two things that you might have is a small vessel vasculitis (resulting from the initial infection) or what we call chronic persistent meningitis of obscure etiology. Usually to distinquish between the two, multiple LPs are necessary and CSF analysis needed. A first step at CCF is usually a MRI with GAD of the spinal cord looking for vasculitis. If found then steriods are the medication of choice. What is thought about the latter, is that it is viral. We search hard for PCR positive HSV, atypical lymphocytes, use T and B cell markers, ANA, etc of the CSF. Frankly, most of the time we come up empty. The Mayo Clinc published a report of 39 (?) of their patients with this disorder and eventually all but 3 recovered. It took months to several years though.

So, I would suggest the MRI and then it depends on what the result comes out like and your desire to find the etiology. Sorry that I couldn't be of more help. The medications suggested sound good, there are others but your physicians will give you what is best.

Sincerely,

CCF Neuro[P] MD

[Neurology Forum]      [Neurology Forum Archives]