Meningitis-retention syndrome (MRS) a combination of acute aseptic meningitis and urinary retention (detrusor underactivity) is a newly-recognized inflammatory neurological condition,[1][2][3][4] therefore the prevalence remains still unknown.
| meningitis-retention syndrome | |
|---|---|
 | |
| Specialty | Uro-neurology |
Presentation edit
MRS occurs in any age, clinically MRS is defined as a combination of a) aseptic meningitis (increased reflexes without leg weakness might be seen; abnormal cerebrospinal fluid alone can also accompany[5]) and b) acute urinary retention. Aseptic meningitis is a common condition, which is caused by many viruses but also from autoimmune etiologies. MRS occurs in 8% of aseptic meningitis cases. Average latencies from the onset of meningeal irritation to urinary symptoms were 0-8 days. However, in some cases, urinary retention precedes fever and headache. The duration of urinary retention in MRS was mostly 7-14 days, lasting up to 10 weeks. Mild acute disseminated encephalomyelitis (ADEM) is considered an underlying mechanism of MRS, because some patients show elevated myelin basic protein in the CSF and a reversible splenial lesion on brain magnetic resonance imaging .[6]
Cause edit
As it is observed in ADEM, antecedent/ comorbid infections or conditions with MRS include Epstein–Barr virus, herpes simplex virus, varicella-zoster virus, West Nile virus, listeria, etc. In addition to these, elevated CSF adenosine deaminase (ADA) levels or decreased CSF/serum glucose ratio may be predictive factors for MRS development.[1]
Diagnosis edit
Urodynamic testing including cystometry show that all patients examined had underactive bladder/detrusor underactivity when on retention. Repeated urodynamics showed that underactive detrusor changed to overactive after a 4-month period, suggesting an upper motor neuron bladder dysfunction (possible spinal shock). MRS should be differentiated from genital herpes (herpes simplex virus,[7][8] varicella-zoster virus[9][10]) and so-called Elsberg syndrome.[11] Clinical/pathological features of Elsberg syndrome were: rare CSF abnormalities; no clinical meningitis; a subacute/chronic course; presentation with typical cauda equina motor-sensory-autonomic syndrome; Wallerian degeneration of the spinal afferent tracts; and mild upper motor neuron signs. All these are different from those of MRS.[12][13][14][15]
Treatment edit
It is believed that MRS is a self-limited disease, the duration of urinary retention in MRS was mostly 7-14 days, lasting up to 10 weeks. While urinary retention in MRS ameliorates in most cases, care must be taken to prevent overdistension bladder injury, by performing clean-intermittent self-catheterization. It is not known whether steroid pulse therapy might shorten the period of urinary retention, because of MRS's self-remitting feature.[16][17]
History edit
This disease was described first by Sakakibara R et al. in 2005.[1]
See also edit
References edit
- ^ a b c Sakakibara R, Uchiyama T, Liu Z, Yamamoto T, Ito T, Uzawa A (2005). "Meningitis-retention syndrome; an unrecognized clinical condition". J Neurol. 252 (12): 1495–1499. doi:10.1007/s00415-005-0897-6. PMID 16021353.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Sakakibara R, Kishi M, Tsuyusaki Y, Tateno A, Tateno F, Uchiyama T, Yamamoto T, Yamanishi T, Yano M (2013). ""Meningitis-retention syndrome": a review". Neurourol Urodyn. 32 (1): 19–23. doi:10.1002/nau.22279. PMID 22674777.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Hiraga A, Kuwabara S (2018). "Meningitis-retention syndrome: Clinical features, frequency and prognosis". J Neurol Sci. 390: 261–264. doi:10.1016/j.jns.2018.05.008. PMID 29801901.
- ^ Sakakibara R (2019). "Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders". Clin Auton Res. 29 (3): 313–320. doi:10.1007/s10286-018-0551-x. PMID 30076494.
- ^ Sakakibara R, Sakai D, Tateno F, Aiba Y. (2020). "Urinary retention with occult meningeal reaction: a 'form fruste' meningitis-retention syndrome". BMJ Case Rep. 13(11): e236625 (11): e236625. doi:10.1136/bcr-2020-236625. PMC 7674081. PMID 33203783.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Tascilar N, Aydemir H, Emre U, Unal A, Atasoy HT, Ekem S. (2009). "Unusual combination of reversible splenial lesion and meningitis-retention syndrome in aseptic meningomyelitis". Clinics (Sao Paulo). 64 (9): 932–937. doi:10.1590/S1807-59322009000900017. PMC 2745142. PMID 19759890.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Sakakibara R, Yamanishi T, Uchiyama T, Hattori T. (2006). "Acute urinary retention due to benign inflammatory nervous diseases". J Neurol. 253 (8): 1103–1110. doi:10.1007/s00415-006-0189-9. PMID 16680560.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Fowler C. (2006). "Short Commentary on "Acute urinary retention due to benign inflammatory nervous diseases" by Sakakibara et al. in J Neurol (2006) 253:1103-1110". J Neurol. 253 (8): 1102. doi:10.1007/s00415-006-0188-x. PMID 16906345.
- ^ Hadžavdić SL, Kovačević M, Skerlev M, Zekan S. (2018). "Genital Herpes Zoster as Possible Indicator of HIV Infection". Acta Dermatovenerol Croat. 26 (4): 337–338. PMID 30665486.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Sakakibara R, Sawai S, Ogata T. (2022). "Varicella-zoster virus infection and autonomic dysfunction". Auton Neurosci. 242:103018. doi:10.1016/j.autneu.2022.103018. PMID 35863181.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Kennedy F, Elsberg CA, Lambert CI. (1913). "A peculiar undescribed disease of the nerves of the cauda equina". Am J Med Sci. 147 (5): 645–647. doi:10.1097/00000441-191405000-00003.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Gheewala GK, Surana DU, Patel A, Daruwala F. (2024). "Meningitis-Retention Syndrome as an Unrecognized Clinical Condition in Indian Scenario: Fall Through the Cracks". Cureus. 16(2):e54910 (2): e54910. doi:10.7759/cureus.54910. PMC 10966420. PMID 38544590.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Wang CH, Huang CN, Wang PW. (2023). "A 10-year-old girl with meningitis retention syndrome and reversible splenial lesion: A case report". Pediatr Neonatol. S1875-9572(23)00202-4 (2): 204–206. doi:10.1016/j.pedneo.2023.08.007. PMID 37951830.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Nagano T, Hosokawa S, Miyahara H, Yamada K, Umeno T, Kano H, Kayatani H, Sakugawa M, Takehisa Y, Takenaka T, Takeuchi M, Bessho A.. (2023). "Urinary Retention Suggesting Aseptic Meningitis: Meningitis-Retention Syndrome Without Physical Signs of Meningeal Irritation". Acta Med Okayama. 77 (2): 199–201. doi:10.18926/AMO/65150. PMID 37094958.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Hidaka M, Sawamura N, Yokoi M, Mezuki S, Osaki M, Arakawa S, Akiyama T, Yamaguchi S, Sayama T, Kitazono T. (2021). "Meningitis retention syndrome associated with complicated mild encephalitis/encephalopathy with reversible splenial lesion in a young adult patient: a case report". Oxf Med Case Reports. 2021(10):omab092 (10): omab092. doi:10.1093/omcr/omab092. PMC 8557460. PMID 34729191.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Suzuki M, Watanabe G, Watari T. (2020). "Epstein-Barr Virus-induced Meningitis-Retention Syndrome". Eur J Case Rep Intern Med. 7(12):002133 (12): 002133. doi:10.12890/2020_002133. PMC 7806303. PMID 33457375.
{{cite journal}}: CS1 maint: multiple names: authors list (link) - ^ Pellegrino, Francesco; Funiciello, Elisa; Pruccoli, Giulia; Silvestro, Erika; Scolfaro, Carlo; Mignone, Federica; Tocchet, Aba; Roasio, Luca; Garazzino, Silvia (June 2023). "Meningitis-retention syndrome: a review and update of an unrecognized clinical condition". Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. 44 (6): 1949–1957. doi:10.1007/s10072-023-06704-0. ISSN 1590-3478. PMC 10175389. PMID 36867276.