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Leptomeningitis is a form of inflammation centred on the sub-arachnoid space.

Leptomeningitis can be divided into three main groups: 

acute purulent meningitis;

lymphocytic meningitis;

chronic/granulomatous meningitides.

Acute purulent meningitis is almost always caused by bacterial infection

Acute purulent meningitis is a severe infection that is nearly always caused by bacterial infection. Patients are severely unwell and have signs of infection, neck stiffness and photophobia. CSF examination shows turbid fluid with many neutrophil polymorphs and a low sugar; bacteria may be seen on special staining.

Macroscopically the sub-arachnoid space contains a cream-coloured acute inflammatory exudate that is rich in neutrophils. The severe inflammation causes secondary thrombosis of superficial vessels and cerebral ischaemic damage.

If treated early, there may be resolution of disease. However, complications caused by organization of the inflammatory exudate may lead to obstruction of the CSF drainage pathways and to development of hydrocephalus.
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