Acute Urinary Retention as an Unusual Manifestation of Aseptic Meningitis.

Abstract

A formerly healthy 32-year-old womanwas hospitalized for a closer examination of undiagnosed fever with mild headache. Despite lack of distinct findings on physical and laboratory examinations at admission, she suddenly developed anuresis due to acontractile neurogenic bladder. On the basis of her symptoms and the faint nuchal rigidity revealed later, as well as the results of cerebrospinal fluid analyses, a diagnosis of aseptic meningitis was eventually reached. While aseptic meningitis subsided within 3 weeks, about 10 weeks, including a 26-day period of anuria, was necessary for complete restoration of normal voiding function, necessitating intermittent self-catheterization. Acute urinary retention should be considered an uncommonbut critical manifestation of aseptic meningitis. (Internal Medicine41 : 392-394, 2002)

Acute urinary retention due to benign inflammatory nervous diseases

“…The clinical manifestations of our cases [7] are mostly the same as those of the six reported cases in the literature [35,36,37,38,39]. The clinical manifestations of MRS cases differ markedly from those of ADEM, because other than presenting with aseptic meningitis, MRS cases lack the following: apparent encephalitic signs such as disturbance of consciousness, epilepsy or aphasia; and myelitic signs such as gait abnormalities, or sensory-level abnormalities.…”

“…Recently the term ''Elsberg syndrome'' has been occasionally used, which is rather vaguely assigned to sacral myeloradiculitis of undetermined etiology [25,26], sacral herpes [7,23,46,47,48,49], sacral vasculitic neuropathy [50], possible MRS [35], possible ADEM [32,33], or conus infarction [51]. According to the textbook 26 in which the term ''Elsberg syndrome'' first appeared:…”

Meningitis–retention syndrome

“…Clinical manifestations of our three MRS patients are mostly the same as those of the six cases in the literature [4][5][6][7][8] (Table 1). All patients had symptoms and signs of meningeal irritation such as headache, stiff neck, and a positive Kernig sign, except for the patient reported by Fukagai et al [6], who had drowsiness without meningeal irritation.…”

“…To our knowledge, only a few case reports of this syndrome are available, most of them having been reported in Japan [4][5][6][7][8] and the underlying pathophysiology of MRS remains unclear. We here describe the results of a uro-neurological assessment in our three patients with MRS.…”

Aseptic meningo–radiculo–encephalitis presenting initially with urinary retention

“…The authors speculated that there was an occurrence of immunologically mediated injury triggered by the herpes infection [14]. Reports of sacral myeloradiculitis other than HSV 2 are rather limited including HSV1 [15],VZV [16], EB virus [17], ECHO virus [18] and unspecified [19][20][21], but benign and transient urinary retention as in HSV2 has been commonly described. In our patients, no evidence of viral infection known to be responsible for the syndrome could be found.…”