Meningitis: aseptic: motor symptoms were common

Clinical bottom line (level 4)

  1. Half of patients with aseptic meningitis had motor symptoms during hospitalisation.
Lepow et al: New England Journal of Medicine 1962; 266 (23): 1188-1193
Lepow et al: New England Journal of Medicine 1962; 266 (23): 1181-1187
Expires November 2003

The study

Case series with unblinded, unobjective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: acute hospital, USA

407 patients (aged 62% under 20yrs, 57% male)

Excluded if
  • previous CNS disease (25 people)




    • 74% followed for length of hospital stay
    Outcomes studied:
  • objective motor symptoms (excluding severely ill)
  • severe illness seizure, coma, paralysis, sensory disturbance, blurred optic discs or other 'severe manifestation'

    • The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    objective motor symptoms length of hospital stay 154/301 51%
    (46% to 56%)
    severe illness length of hospital stay 47/407 11%
    (8.4% to 15%)

    Comments

    1. Clinically, it is important to note that problems resolved over the course of prolonged follow-up.
    2. Current causes and outcomes may differ from those of the late 1950's
    3. 24% had Coxsackie virus, 14% Echovirus, 7% Poliovirus, 6% Mumps and 3% had mixed infections (based on isolation from CSF, throat swabs or faeces).

    Citation

    1. Lepow ML, Coyne N, Thompson LB, et al: a clinical epidemiologic and laboratory investigation of aseptic meningitis during the four-year period, 1955-1958 II: the clinical disease and its sequelae. New England Journal of Medicine 1962; 266 (23): 1188-1193
    2. Lepow ML, Carver DH, Wright HT, et al: Clinical, epidemiologic and laboratory investigation of aseptic meningitis during the four-year period, 1955-1958 1. observations concerning etiology and epidemiology. New England Journal of Medicine 1962; 266 (23): 1181-1187
    Search Terms: reference from 'Quick Consult Manual to Evidence-based Medicine'; Lee, Hsu, Stasior; publ. Little-Brown 1997
    Contributor: Chris Ball & Bob Phillips, November 1999
    Reviewer: Michael Nielsen

    Clinical Question.
    Patient aseptic meningitis
    Intervention or Exposure
    Outcome motor symptoms, coma