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Inicio Neurología (English Edition) Meningitis associated with spinal anaesthesia: not always bacterial
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Vol. 26. Issue 7.
Pages 442 (September 2011)
Vol. 26. Issue 7.
Pages 442 (September 2011)
Letter to the Editor
DOI: 10.1016/j.nrleng.2010.12.003
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Meningitis associated with spinal anaesthesia: not always bacterial
Meningitis asociada a anestesia espinal: no siempre bacteriana
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S. Reus Bañulsa,??
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reus_ser@gva.es

Corresponding author.
, S. Bustos Terolb, S. Olmos Sotoa, D. Piñar Cabezosa
a Unidad de Enfermedades Infecciosas, Hospital General Universitario de Alicante, Alicante, Spain
b Sección de Neurología, Hospital Clínico de San Juan, Alicante, Spain
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Sir,

Laguna del Estal et al.1 have recently reported a series of patients with bacterial meningitis associated with epidural analgesia and anaesthesia, and in their discussion they quite rightly pointed out that the differential diagnosis must include chemical meningitis.1 It is important to stress that meningitis induced by the local administration of anaesthetics must also be suspected whenever the cultures are negative. The clinical picture produced is indistinguishable from that of bacterial meningitis, but what many clinicians are unaware of is that the cerebrospinal fluid (CSF) may also be negative, revealing intense pleocytosis and polymorphonuclear predominance. These situations are well documented with, for example, bupivacaine, which may trigger pleocytosis of several thousand leucocytes with a percentage of polymorphonuclear cells close to 100%.2–4 Some important facts may help distinguish between bacterial and aseptic meningitis. First of all, the latency between epidural anaesthesia and the onset of symptoms as a time of less than 6h suggests that it is chemical meningitis. Second, the presence of eosinophilia in CSF, which is “never” seen in bacterial meningitis but is in drug-induced meningitis, or else that the patient presents atopy. Third, the presence of hypoglycorrachia less than 30mg/dL, typically occurring in bacterial forms (albeit also described in aseptic cases). And finally, a frank elevation of acute phase reactants, common only in bacterial meningitides.

References
[1]
P. Laguna del Estal, A. Castañeda, M. López-Cano, P. García Montero.
Meningitis bacteriana asociada a analgesia y anestesia espinal.
Neurología, 25 (2010), pp. 552-556
[2]
A.G. Besocke, R. Santamarina, L.M. Romano, R.A. Femminini.
Meningitis aséptica inducida por bupivacaína.
Neurología, 22 (2007), pp. 551-552
[3]
M. Santos, B.C. Albuquerque, R. Monte, G. Filho, M. Alecrim.
Outbreak of chemical meningitis following spinal anestesia caused by chemically related bupivacaine.
Infect Control Hosp Epidemiol, 30 (2009), pp. 922-933
[4]
F. Tateno, R. Sakakibara, M. Kishi, E. Ogawa.
Bupivacaine-induced chemical meningitis.
J Neurol, 257 (2010), pp. 1327-1329

Please cite this article as: Reus Bañuls S, et al. Meningitis asociada a anestesia espinal: no siempre bacteriana. Neurología. 2011;26:442.

Copyright © 2010. Sociedad Española de Neurología
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