Chronic and subacute meningitis

Continuum (Minneap Minn). 2012 Dec;18(6 Infectious Disease):1290-318. doi: 10.1212/01.CON.0000423848.17276.21.


Purpose of review: This article describes the background, clinical presentation, diagnosis, and treatment of selected etiologies of subacute and chronic meningitis. Key diagnostic considerations when evaluating a patient presenting with chronic inflammation of the CNS are discussed, and several specific infectious, neoplastic, and autoimmune etiologies are reviewed in detail.

Recent findings: With recent advancement in serologic and CSF diagnostic testing, specific infectious, neoplastic, or autoimmune etiologies of chronic meningitis can be identified. Eliminating previous diagnostic uncertainty of chronic inflammation in the CNS has led to rapid and specific treatment regimens that ultimately improve patient outcomes. Recent advances in imaging have also aided clinicians in both their diagnostic approach and the detection of inflammatory complications such as hydrocephalus, hemorrhage, and ischemic stroke.

Summary: Meningitis is defined as inflammation involving the meninges of the brain and spinal cord. Meningitis can be categorized as acute, subacute, or chronic based on duration of inflammation. This article focuses on the most common causes of subacute and chronic meningitis. Chronic meningitis is commonly defined as inflammation evolving during weeks to months without resolution of CSF abnormalities. Determining the time course of meningitis is important for creating a differential diagnosis. Most organisms causing acute meningitis rarely persist more than a few weeks. Although numerous etiologies of subacute and chronic meningitis have been identified, this article focuses on the most common etiologies: (1) infectious, (2) autoimmune, and (3) neoplastic.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acute Disease
  • Adult
  • Antifungal Agents / therapeutic use
  • Behcet Syndrome / diagnosis
  • Behcet Syndrome / drug therapy
  • Blastomycosis / diagnosis
  • Blastomycosis / drug therapy
  • Central Nervous System Diseases / diagnosis
  • Central Nervous System Diseases / drug therapy
  • Chronic Disease
  • Coccidioidomycosis / diagnosis
  • Coccidioidomycosis / drug therapy
  • Early Detection of Cancer
  • Fatal Outcome
  • Female
  • Histoplasmosis / diagnosis
  • Histoplasmosis / drug therapy
  • Humans
  • Lupus Erythematosus, Systemic / diagnosis
  • Lupus Erythematosus, Systemic / drug therapy
  • Male
  • Meningeal Carcinomatosis / diagnosis
  • Meningeal Carcinomatosis / drug therapy
  • Meningitis / diagnosis
  • Meningitis / drug therapy
  • Meningitis / etiology*
  • Meningitis, Bacterial / diagnosis
  • Meningitis, Bacterial / drug therapy
  • Meningitis, Bacterial / microbiology
  • Meningitis, Cryptococcal / diagnosis
  • Meningitis, Cryptococcal / drug therapy
  • Meningitis, Fungal / diagnosis
  • Meningitis, Fungal / drug therapy
  • Meningitis, Fungal / microbiology
  • Middle Aged
  • Mycobacterium tuberculosis
  • Neuroaspergillosis / diagnosis
  • Neuroaspergillosis / drug therapy
  • Neurosyphilis / diagnosis
  • Neurosyphilis / drug therapy
  • Sarcoidosis / diagnosis
  • Sarcoidosis / drug therapy
  • Tuberculosis, Meningeal / diagnosis
  • Tuberculosis, Meningeal / drug therapy
  • Vasculitis, Central Nervous System / diagnosis
  • Vasculitis, Central Nervous System / drug therapy


  • Antifungal Agents

Supplementary concepts

  • Neurosarcoidosis
  • Primary angiitis of the central nervous system