Benign recurrent meningitis, also known as Mollaret's meningitis (MM), is characterized by recurrent headache, fever, meningeal irritation and sterility of cerebrospinal fluid examination, which is rare in clinic. Although with clear diagnostic criteria, there are still many unclear aspects of its pathogenesis, and treatment of this disease. The author reported a case of benign recurrent aseptic meningitis, who had three episodes of acute headache with or without fever. The patient was treated with ceftriaxone, acyclovir and cefazoxime for the first time, cefazoxime, cefimidazole and mebendazole for the second time, and piperacillin and acyclovir for the third time. The results showed that the patient did not recover completely in the first two times and fully recovered at the third time. Based on the current research, the author believes that for MM, mainly symptomatic relief, indomethacin should be recommended, and too much antiviral treatment is not needed.

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Background Acute vestibular syndrome (AVS) is a common clinical syndrome in neurology clinics and emergency department. Canonical standard for AVS diagnosis requires the presence of persistent vertigo for more than 24 h. HINTS (head impulse-nystagmus-test of skew) is an emerging scheme in the diagnosis of AVS. In this prospective study, we evaluated the specificity and sensitivity of HINTS in distinguishing between central and peripheral AVS. Methods A cohort of 239 cases with complete clinical record was recruited in the study. All patients completed emergency brain CT examination to exclude hemorrhagic stroke. HINTS examination was conducted to distinguish between central AVS and peripheral AVS, and all patients completed head MRI, BAEP and vestibular function examinations within one week. Patients diagnosed as central AVS were subject to angiography (CTA/MRA/DSA), and patients with peripheral AVS were considered for a 3-month follow-up to correct the initial diagnosis. Results Patients with central AVS were associated with an elder age, higher incidences of hypertension, atrial fibrillation, family history of stroke and previous history of stroke. Posterior circulation cerebral infarction, vestibular migraine and cerebellitis were the dominant diseases associated with central AVS. The sensitivities of HIT, GE, and TS in the diagnosis of central AVS were 73.5%, 61.2%, and 26.5%, and the specificities were 97.9%, 92.6%, and 93.2% respectively. Conclusions The sensitivity of HINTS for central AVS diagnosis is 89.8% and the specificity is 84.2%. HINTS is an easy-to-operate, low-cost, high-sensitivity and specific examination technique, which is practical in neurology outpatient clinics and emergency departments.