Spinal Meningitis: Your Questions, Answered

Meningitis: It’s not just for the brain. Learn how to recognize and treat it in the spinal cord.

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Most people think of meningitis as a brain disease, but did you know it can also affect your spine? Spinal meningitis is a potentially deadly infection of the meninges, the protective tissue covering the brain and spinal cord. It can be caused by specific viruses, bacteria, or fungi that gets transmitted from person to person by sneezing, talking, kissing, or sharing food or drinks.

Spinal meningitisNeck pain is a common symptom of spinal meningitis.

The same kinds of viruses and pathogens that cause other infections, such as mumps and measles, can also cause meningitis. The lining around the brain and the spine are connected to infection can travel from one site to the other, or stay in either the brain or the spine.

We know you have questions about spinal meningitis. Here are some answers.

What Are the Meninges?

Meninges are the protective membranes surrounding the brain and spinal cord. They’re comprised of three layers:

  • Pia mater: An inner delicate layer of cells
  • Arachnoid mater: A middle layer of comprised of strands of connective tissue
  • Dura mater: A thick and tough outer layer

Spinal meningitis can develop when a virus, bacteria, or other pathogen invades the meninges layers, activates the immune system, and causes inflammation. Typically, spinal meningitis-causing organisms reside in the nose and throat and never cause problems.

Most people who come into contact with these harmful pathogens never get sick, even children. The body produces disease-fighting antibodies before the pathogens invades the meninges. Others aren’t so lucky, which makes them vulnerable to the illness. When brain and spinal tissue becomes infected with one of these pathogens, the tissue swells, hampering blood flow to the brain.

What Are the Main Types of Spinal Meningitis? 

The two most common types of spinal meningitis in the U.S. include:

Viral meningitis: Viral meningitis is caused by enteroviruses, common viruses that enter the body through your mouth and travel to the brain and surrounding tissues where they multiply. But other viruses can also cause meningitis, including the viruses that cause mumps, herpesviruses, including Epstein-Barr, measles, influenza, West Nile virus and lymphocytic choriomeningitis virus from rodents. If any of these viruses spread to the meninges, spinal meningitis can develop. This is usually less severe than bacterial meningitis.

Bacterial meningitis: This type of spinal meningitis is caused when harmful bacteria invade the meninges. This is generally more dangerous than viral meningitis and can be fatal if not treated. Three of the most common types of bacterial meningitis include:

  1. Haemophilus influenzae (Hib) can cause severe infections of both the lining of the brain and spinal cord (meningitis) and the bloodstream.
     
  2. Pneumococcal meningitis, which is caused by the bacterium Streptococcus pneumoniae. Pneumococcal meningitis is the most common form of bacterial meningitis, which affects about 6,000 in the U.S. each year.
  1. Meningococcal meningitis, also known as meningococcal disease, is a less common type of bacterial meningitis. Meningococcal meningitis is caused by the bacterium Neisseria meningitides and affects roughly 2,600 people in the U.S. annually, according to the National Institute of Neurological Disorders and Stroke.

Spinal meningitis vaccineVaccines for viral meningitis are available.

What Are Spinal Meningitis Symptoms?

Viral or bacterial spinal meningitis can cause a range of symptoms, including:

  • Fever
  • Fatigue
  • Rash
  • Neck and back stiffness
  • Sensitivity to light
  • Nausea
  • Vomiting
  • Double vision
  • Drowsiness
  • Hearing difficulty
  • Muscle weakness
  • Headache
  • Confusion
  • Inconsolable crying (infants/toddlers)
  • Difficulty being awakened (infants/toddlers)
  • Seizures
  • Changes in behavior

Symptoms tend to be more pronounced with the bacterial form of the disease because it’s often associated with more inflammation, compared to viral meningitis.

What Complications Can Spinal Meningitis Cause?

Depending on the type of meningitis (viral or bacterial), the results of this brain and spinal cord infection can be serious, leading to permanent brain and organ damage, stroke, loss of hearing or limbs or even death. Anyone who experiences symptoms of meningitis should see a doctor right away for diagnosis and treatment. Don’t wait, hoping you or your child will feel better. Spinal meningitis can get serious quickly. Small details, especially in young children, can be help your doctor decide what to do next

Who Is at Risk for Spinal Meningitis?

How do you get spinal meningitis? Age, immune status, residing in a group environment or having a compromised immune system can increase the risk of contracting the disease.

Children younger than age 5 and people with weakened immune systems from disease, medications, or having a recent organ or bone marrow transplants are at increased risk for viral meningitis. Babies younger than 1 month old and those with weakened immunes systems are also more likely to experience severe illness from viral meningitis. Fortunately, most causes of viral meningitis aren’t serious. Most children recover in one to two weeks.

Those at increased risk for bacterial meningitis include children under age 2 and adults with a weakened immune system from a condition such as HIV or diabetes, steroid use or chemotherapy treatment. Children under age 1 and people with suppressed immune systems, college students and others who reside in dormitories, and travelers to countries where meningococcal meningitis is endemic, such as sub-Saharan Africa, are also at increased risk for meningococcal disease, which can cause spinal meningitis.

Spinal meningitis riskLiving in tight quarters such as dorms or barracks can increase meningitis risk.

Meningitis can also occur very rarely after spine surgery where the lining around the dura is torn and at the same time a wound infection occurs.

How Is Spinal Meningitis Diagnosed?

If you’re a parent with a sick child, be prepared to tell the doctor:

  • Your child’s temperature and the temperature-taking method you used
  • How long it has been since giving your child fever-reducing medication, if any
  • Your child’s behavior, such as: “She doesn’t want to eat and is very fussy”

To detect spinal meningitis, doctors may perform blood tests, imaging tests and a spinal tap to test cerebrospinal fluid, which surrounds the brain and spinal cord. Spinal fluid is collected and sent to the lab, where it’s analyzed to see if specific bacteria or viruses are present.

How Is Spinal Meningitis Treated? 

Antiviral medication may help treat some types of viral meningitis. Other medication may be available to treat meningitis symptoms. Doctors typically recommend bed rest, plenty of fluids, and medicine to relieve fever and headache for viral meningitis.

Antibiotic medication is available to help treat bacterial spinal meningitis. The disease is typically treated with intravenous antibiotics in the hospital. Nonetheless, about 10 percent of children with bacterial meningitis die from it every year. Even if antibiotics are started quickly, a child can be overwhelmed by the organism.

Meningococcus (Neisseria meningitidis bacterium) is especially stealthy because it can make a toxin that invades the bloodstream, killing a child or adolescent within hours. That’s among the chief reasons why it’s much better to try to prevent bacterial meningitis than to treat it after the fact.

Is Spinal Meningitis Contagious?

Yes, that’s why good hygiene, such as handwashing before and after meals and using the bathroom, and not sharing food, beverages, utensils or lip balm can help stop the spread of bacterial and viral meningitis. But getting recommended vaccinations is one of the most important steps parents can take to protect their children from the bacterial forms of the disease.

Vaccines, including Haemophilus influenzae type b (abbreviated Hib, PRP-T and PRP-OMP), pneumococcal (PCV13 and PPSV23) and meningococcal MenACWY-D, MenACWY-CRM, MenB-4C and MenBFHbp) are available that have reduced all three forms of bacterial meningitis in children and young adults.

The CDC has a complete immunization schedule. If you miss a vaccination, your child can catch up, so don’t let that stop you from getting your child fully immunized. And don’t worry. Your child can’t get the disease from the vaccination. Side effects from the vaccines are generally mild, such as redness and swelling at the injection site that can last up to two days.

Updated on: 06/15/20
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The Spine’s Self-Defense System
Lali Sekhon, MD, PhD, FAANS, FRACS, FACS
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