Chemical meningitis following cerebellopontine angle tumor surgery.
OBJECTIVE
Postoperative chemical meningitis mimics bacterial meningitis, complicating the diagnosis until results of cerebrospinal fluid (CSF) cultures can be obtained. We analyzed clinical and laboratory data from a series of 1146 patients to identify findings that could exclude bacterial meningitis.


METHODS
We reviewed the charts of patients who developed meningitis after cerebellopontine angle surgery. Lumbar puncture data from asymptomatic postoperative patients were our control.


METHODS
Clinical symptoms, CSF profiles, and serum white blood cell (WBC) counts were compared between patients with chemical meningitis, bacterial meningitis, and asymptomatic patients.


RESULTS
The incidence of meningitis in our series of 1146 patients was 4.54 percent; 0.87 percent was culture-proven bacterial meningitis. The patients with bacterial meningitis had significantly higher CSF and serum WBC counts, and lower CSF glucose. The major difference between asymptomatic patients and those with chemical meningitis was the significantly lower ratio of CSF WBCs to red blood cells (RBCs) in asymptomatic patients.


CONCLUSIONS
Patients with mild CSF leukocytosis and normal CSF glucose without high serum WBC counts or focal neurological deficits may be treated for chemical meningitis.
Sanchez
Gabriela B
GB
Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN 37232, USA. Gabriela.sanchez@vanderbilt.edu
Kaylie
David M
DM
O'Malley
Matthew R
MR
Labadie
Robert F
RF
Jackson
C Gary
CG
Haynes
David S
DS
D006801:Humans; D007958:Leukocyte Count; D008582:Meningitis, Aseptic / Q000209:etiology*; D016920:Meningitis, Bacterial / Q000175:diagnosis; D009464:Neuroma, Acoustic / Q000601:surgery*; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D011183:Postoperative Complications / Q000175:diagnosis; D012189:Retrospective Studies