LEPTOMENINGEAL AND BRAIN BIOPSY IN CHRONIC MENINGITIS

Background: The cause is not found in one third of patients presenting with chronic meningitis. Biopsy of the leptomeninges and brain is oft en recommended in these patients, but the value of a biopsy is uncerta in. Aims: To review the results of leptomeningeal and brain biopsies a nd their effect on diagnosis and management in patients with chronic m eningitis, if the diagnosis was uncertain after clinical assessment, l umbar puncture and radiological investigations. Methods: The clinical features, investigations and the results of leptomeningeal and brain b iopsies were reviewed retrospectively in 25 patients presenting with c hronic meningitis between 1967 and 1990. Results: The biopsy identifie d the cause of the chronic meningitis in five patients (neoplastic men ingitis in three, tuberculous meningitis in one, granulomatous angiiti s in one). In 17 patients the biopsy was abnormal but it did not ident ify the cause (non-granulomatous lymphocytic meningitis in eight, gran ulomatous meningitis in two, non-specific abnormalities in seven). In two patients the biopsy was normal and in one patient the tissue was u sed only for culture. The results of the biopsy led to a beneficial ch ange in treatment in two patients but did not influence management in the other patients. Conclusions: A leptomeningeal and brain biopsy was of limited practical value in diagnosis and management in most patien ts with chronic meningitis.