Meningitis-retention syndrome (MRS) a combination of acute aseptic meningitis and urinary retention (detrusor underactivity) is a newly-recognized inflammatory neurological condition,[1][2][3][4] therefore the prevalence remains still unknown.
MRS occurs in any age, clinically MRS is defined as a combination of a) aseptic meningitis (increased reflexes without leg weakness might be seen; abnormal cerebrospinal fluid alone can also accompany[5]) and b) acute urinary retention. Aseptic meningitis is a common condition, which is caused by many viruses but also from autoimmune etiologies. MRS occurs in 8% of aseptic meningitis cases. Average latencies from the onset of meningeal irritation to urinary symptoms were 0–8 days. However, in some cases, urinary retention precedes fever and headache. The duration of urinary retention in MRS was mostly 7–14 days, lasting up to 10 weeks. Mild acute disseminated encephalomyelitis (ADEM) is considered an underlying mechanism of MRS, because some patients show elevated myelin basic protein in the CSF and a reversible splenial lesion on brain magnetic resonance imaging .[6]
Urodynamic testing including cystometry show that all patients examined had underactive bladder/detrusor underactivity when on retention. Repeated urodynamics showed that underactive detrusor changed to overactive after a 4-month period, suggesting an upper motor neuron bladder dysfunction (possible spinal shock). MRS should be differentiated from genital herpes (herpes simplex virus,[7][8]varicella-zoster virus[9][10]) and so-called Elsberg syndrome.[11] Clinical/pathological features of Elsberg syndrome were: rare CSF abnormalities; no clinical meningitis; a subacute/chronic course; presentation with typical cauda equina motor-sensory-autonomic syndrome; Wallerian degeneration of the spinal afferent tracts; and mild upper motor neuron signs. All these are different from those of MRS.[12][13][14][15]
It is believed that MRS is a self-limited disease, the duration of urinary retention in MRS was mostly 7–14 days, lasting up to 10 weeks. While urinary retention in MRS ameliorates in most cases, care must be taken to prevent overdistension bladder injury, by performing clean-intermittent self-catheterization. It is not known whether steroid pulse therapy might shorten the period of urinary retention, because of MRS's self-remitting feature.[16][17]
^ abcSakakibara R, Uchiyama T, Liu Z, Yamamoto T, Ito T, Uzawa A (2005). "Meningitis-retention syndrome; an unrecognized clinical condition". J Neurol. 252 (12): 1495–1499. doi:10.1007/s00415-005-0897-6. PMID16021353.((cite journal)): CS1 maint: multiple names: authors list (link)
^Sakakibara R, Kishi M, Tsuyusaki Y, Tateno A, Tateno F, Uchiyama T, Yamamoto T, Yamanishi T, Yano M (2013). ""Meningitis-retention syndrome": a review". Neurourol Urodyn. 32 (1): 19–23. doi:10.1002/nau.22279. PMID22674777.((cite journal)): CS1 maint: multiple names: authors list (link)
^Hiraga A, Kuwabara S (2018). "Meningitis-retention syndrome: Clinical features, frequency and prognosis". J Neurol Sci. 390: 261–264. doi:10.1016/j.jns.2018.05.008. PMID29801901.
^Sakakibara R (2019). "Neurogenic lower urinary tract dysfunction in multiple sclerosis, neuromyelitis optica, and related disorders". Clin Auton Res. 29 (3): 313–320. doi:10.1007/s10286-018-0551-x. PMID30076494.
^Sakakibara R, Yamanishi T, Uchiyama T, Hattori T. (2006). "Acute urinary retention due to benign inflammatory nervous diseases". J Neurol. 253 (8): 1103–1110. doi:10.1007/s00415-006-0189-9. PMID16680560.((cite journal)): CS1 maint: multiple names: authors list (link)
^Fowler C. (2006). "Short Commentary on "Acute urinary retention due to benign inflammatory nervous diseases" by Sakakibara et al. in J Neurol (2006) 253:1103-1110". J Neurol. 253 (8): 1102. doi:10.1007/s00415-006-0188-x. PMID16906345.
^Hadžavdić SL, Kovačević M, Skerlev M, Zekan S. (2018). "Genital Herpes Zoster as Possible Indicator of HIV Infection". Acta Dermatovenerol Croat. 26 (4): 337–338. PMID30665486.((cite journal)): CS1 maint: multiple names: authors list (link)
^Sakakibara R, Sawai S, Ogata T. (2022). "Varicella-zoster virus infection and autonomic dysfunction". Auton Neurosci. 242:103018. doi:10.1016/j.autneu.2022.103018. PMID35863181.((cite journal)): CS1 maint: multiple names: authors list (link)
^Kennedy F, Elsberg CA, Lambert CI. (1913). "A peculiar undescribed disease of the nerves of the cauda equina". Am J Med Sci. 147 (5): 645–647. doi:10.1097/00000441-191405000-00003.((cite journal)): CS1 maint: multiple names: authors list (link)