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Tried of meningitis

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meningitis

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CDC meningitis symptoms fever stiff neck altered mental status

If you mean the classic triad of meningitis:
  1. Fever
  2. Headache
  3. Neck stiffness
Altered mental status such as confusion or drowsiness is also a common serious feature. The full triad is not present in everyone, so meningitis can still occur without all three signs.
Seek emergency care now for sudden fever with severe headache, stiff neck, confusion, vomiting, light sensitivity, seizure, or a purple/non-blanching rash. The CDC describes these warning signs as potentially rapidly progressive.

FLAMES in MOGAD

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MOGAD AND FLAMES

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MOGAD AND FLAMES

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FLAMES MOGAD clinical MRI features treatment review

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FLAMES MOGAD MRI unilateral cortical FLAIR hyperintensity leptomeningeal enhancement

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https://pmc.ncbi.nlm.nih.gov/articles/PMC9247462/

FLAMES is a cortical encephalitis phenotype of MOG antibody-associated disease (MOGAD).

Full form

FLAIR-hyperintense
Lesions in
Anti-MOG-associated
Encephalitis with
Seizures

Typical presentation

Usually an acute meningo-cortical syndrome with:
  • Focal or generalized seizures, sometimes status epilepticus
  • Headache and fever
  • Encephalopathy or confusion
  • Focal cortical deficits such as aphasia, weakness, or visual symptoms
  • CSF inflammation, often with marked lymphocytic pleocytosis, which can make it resemble infectious meningitis/encephalitis

MRI hallmark

  • Unilateral cortical T2/FLAIR hyperintensity, commonly frontal, temporal, or parietal
  • Usually little or no deep white-matter involvement
  • May have corresponding leptomeningeal enhancement
  • Although “unilateral” is in the name, bilateral cortical disease can occur, particularly in more severe presentations.

Diagnosis

Diagnosis requires a compatible clinical-radiologic phenotype plus MOG-IgG positivity, preferably detected in serum using a live cell-based assay. Testing should be interpreted carefully: a low-positive result without a compatible syndrome can be false positive. Exclude infections first with CSF studies and relevant microbiology, because presentation can closely mimic viral or bacterial meningoencephalitis.

Treatment and outcome

Treat the acute attack as MOGAD after appropriate infection assessment:
  • IV high-dose corticosteroids are usual first-line treatment.
  • IVIG or plasma exchange may be used for severe or steroid-refractory attacks.
  • Antiseizure medication for acute seizure control.
  • A gradual oral steroid taper is often considered because early relapse can occur.
Many patients improve substantially with immunotherapy, and MRI lesions may resolve. Long-term relapse-prevention treatment is individualized based on relapse history and other MOGAD attacks.
FLAMES is a rare phenotype, so recent evidence is mostly reviews and case series rather than large trials. A useful MOGAD clinical and MRI review describes the characteristic seizures, CSF pleocytosis, unilateral cortical FLAIR lesion, and leptomeningeal enhancement. A 2022 review of the broader meningo-cortical MOGAD spectrum is indexed as PMID 36341089.
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