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Aseptic meningoencephalitis mimicking transient ischaemic attacks

  • Clinical and Epidemiological Study
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Abstract

Purpose

To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis.

Methods

This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit.

Results

A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings.

Conclusions

Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke source.

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Acknowledgments

The authors acknowledge their sincere gratitude to M. Schluep, MD who contributed significantly in the retrieval of the LP results for the 27 TIA patients.

Conflict of interest

On behalf of all the authors, the corresponding author states that there is no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Medicine, University of Thessaly, 41110, Biopolis, Larissa, Greece

    V. Papavasileiou & G. Ntaios

  2. Stroke Unit, Neurology Service, University of Lausanne, Centre Hospitalier Universitaire Vaudois, BH13/204, Rue de Bugnon 46, 1011, Lausanne, Switzerland

    V. Papavasileiou, H. Milionis, M. Cordier, A. Eskandari, G. Ntaios & P. Michel

Authors
  1. V. Papavasileiou
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  2. H. Milionis
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  6. P. Michel
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Corresponding author

Correspondence to P. Michel.

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Papavasileiou, V., Milionis, H., Cordier, M. et al. Aseptic meningoencephalitis mimicking transient ischaemic attacks. Infection 41, 485–491 (2013). https://doi.org/10.1007/s15010-012-0397-4

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