title: Aseptic meningoencephalitis mimicking transient ischaemic attacks.
abstract: OBJECTIVE
  To highlight meningoencephalitis as a transient ischaemic attack (TIA) mimic and suggest clinical clues for differential diagnosis.
  
  
  METHODS
  This was an observational study of consecutively admitted patients over a 9.75-year period presenting as TIAs at a stroke unit.
  
  
  RESULTS
  A total of 790 patients with TIAs and seven with TIA-like symptoms but a final diagnosis of viral meningoencephalitis were recognised. The most frequent presentations of meningoencephalitis patients were acute sensory hemisyndrome (6) and cognitive deficits (5). Signs of meningeal irritation were minor or absent on presentation. Predominantly lymphocytic pleocytosis, hyperproteinorachia and a normal cerebrospinal fluid (CSF)/serum glucose index (in 5 out of 6 documented patients) were present. Meningeal thickening on a brain magnetic resonance imaging (MRI) scan was the only abnormal imaging finding. Six patients received initial vascular treatment; one thrombolysed. Finally, six patients were treated with antivirals and/or antibiotics. Although neither bacterial nor viral agents were identified on extensive testing, viral meningoencephalitis was the best explanation for all clinical and laboratory findings.
  
  
  CONCLUSIONS
  Aseptic meningoencephalitis should be part of the differential diagnosis in patients presenting as TIA. The threshold for a lumbar puncture in such patients should be set individually and take into account the presence of mild meningeal symptoms, age and other risk factors for vascular disease, the results of brain imaging and the basic diagnostic work-up for a stroke source.
authors: Department of Medicine, University of Thessaly, 41110, Biopolis, Larissa, Greece.
authors: V
authors: V
authors: Papavasileiou
authors: H
authors: H
authors: Milionis
authors: M
authors: M
authors: Cordier
authors: A
authors: A
authors: Eskandari
authors: G
authors: G
authors: Ntaios
authors: P
authors: P
authors: Michel
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000998:Antiviral Agents / Q000008:administration & dosage; D001921:Brain / Q000000981:diagnostic imaging; D003072:Cognition Disorders / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000175:diagnosis* / Q000188:drug therapy; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D011859:Radiography; D018139:Simplexvirus; D020521:Stroke / Q000473:pathology*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000998:Antiviral Agents