The course may be fulminant, but most often appears as relapses. Inflammation is most intense at the base of the brain where cranial nerve palsies, cerebellar dysfunction, and hydrocephalus may be found. Ventriculitis may b e caused by chronic infection. Localized granulomatous infections in the cervical or thoracic re gions also occur occasionally. Granulomas rarely found in the brain.
Diagnosis can be difficult.
Half the patients with meningitis may be anergic . CSF exam m ay be normal on a single exam. When positive, the CSF may show low glucose, raised protein, and a modest pleoc ytosis along with eosinophilia. Rare to find organisms. IgM antibodies, complement fixation antibodies may help on the CSF and blood specimens.