Meningitis-retention syndrome. An unrecognized clinical condition.
BACKGROUND
A combination of acute urinary retention and aseptic meningitis has not been well known. This combination can be referred to as meningitis-retention syndrome (MRS), when accompanied by no other abnormalities.


OBJECTIVE
To describe the results of a uro-neurological assessment in our patients with MRS.


METHODS
In three patients (two men, one woman; age, 34-68 years), we performed urodynamic studies and relevant imaging and neurophysiological tests, in addition to cerebrospinal fluid (CSF) examination.


RESULTS
All three patients developed acute urinary retention along with headache, fever and stiff neck. None had obvious neurological abnormalities, other than a slightly brisk reflex in the lower extremities. One had previously experienced generalized erythematous eruptions, but none had pain, hypalgesia or skin eruptions in the sacral dermatomes suggestive of Elsberg syndrome (infectious sacral polyradiculitis; mostly genital herpes). Brain/spinal/lumbar plexus MRI scans and nerve conduction studies were normal. CSF examination showed mild mononuclear pleocytosis, increased protein content, and normal to mildly decreased glucose content in all patients; increased myelin basic protein suggestive of central nervous system demyelination in one; and increased viral titers in none. Urodynamic study revealed, during the voiding phase, an underactive detrusor in all patients and an unrelaxing sphincter in one. These clinical manifestations were ameliorated within 3 weeks.


CONCLUSIONS
We reported three cases of MRS, a peculiar syndrome that could be regarded as a mild variant of acute disseminated encephalomyelitis (ADEM). Urinary retention might reflect acute shock phase of this disorder. Although MRS has a benign and self-remitting course, management of the acute urinary retention is necessary.
Sakakibara
Ryuji
R
Dept. of Neurology, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan. sakakibara@faculty.chiba-u.jp
Uchiyama
Tomoyuki
T
Liu
Zhi
Z
Yamamoto
Tatsuya
T
Ito
Takashi
T
Uzawa
Akiyuki
A
Suenaga
Tadahiro
T
Kanai
Kazuaki
K
Awa
Yusuke
Y
Sugiyama
Yoshiki
Y
Hattori
Takamichi
T
D000328:Adult; D000368:Aged; D001921:Brain / Q000473:pathology; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D005334:Fever / Q000209:etiology; D006261:Headache / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000150:complications*; D008875:Middle Aged; D009460:Neurologic Examination / Q000379:methods; D013116:Spinal Cord / Q000473:pathology; D016055:Urinary Retention / Q000134:cerebrospinal fluid / Q000209:etiology* / Q000821:virology