Meningitis-retention Syndrome

While acute prostatitis is a relatively common disease with a bimodal distribution, meningitis-retention syndrome (MRS) is a significantly rarer disease that is more likely to present in young, healthy adults.^6,8

MRS will typically present with neurological signs highly suggestive of aseptic meningitis, including “headache, drowsiness, fever… nuchal rigidity and positive Kernig and/or Brudzinski signs.”⁸ However, in many cases, the neurological signs may be so mild that the predominant symptom appears to be “isolated acute urinary retention.”⁹ One of the most notable presentations of MRS is the fever and AUR that patients with it will eventually develop. Only newly reported in the literature, the cause of MRS remains undetermined in most cases.⁸

Distinguishing it further from acute prostatitis, MRS patients will display a neurogenic bladder during urodynamic studies.⁸ Unusually, MRS patients will not display any evidence of lower motor neuron involvement—with a “lack of leg numbness and paresthesias help[ing] to differentiate MRS from Guillain-Barre syndrome, polyneuropathies and conditions affecting the lower motor neurons.”⁸ It is theorized that MRS affects upper motor neurons in the central nervous system responsible for the detrusor muscle.⁸ Likewise, patients with MRS display normal peripheral nerve conduction.⁹

The presence of MRS may be confirmed with lumbar puncture, which will display “lymphocytic pleocytosis, elevated protein levels, and mildly decreased glucose levels.”⁸ MRI of the brain and spinal cord will not reveal any abnormalities—nor will blood or urine cultures.⁹ Patients with MRS should have their AUR treated by catheterization and be admitted for observation. There is no evidence to suggest that treatment with steroids, antibiotics, or antivirals improves the disease course or hastens recovery.⁹ Fortunately, the disease is self-limiting over a period of several weeks, and there is no evidence of long-term neurological sequelae.⁸

Pharmacology

In elderly patients, pharmacological causes of AUR with fever should also be considered, given the “decreased clearance, drug interactions, altered drug sensitivity and multiple comorbid medical conditions more common with advancing age.”¹⁰

Pharmacologic etiologies account for up to 10 percent of AUR cases.² Drugs with anticholinergic effects should be strongly considered. Even localized anticholinergic drugs, such as short-acting and long-acting anticholinergic bronchodilators such as ipratropium and oxitropium, may cause AUR. Atropine eye drops have also been found to induce AUR.² Other medications at risk for causing AUR include antihistamines, class 1 antiarrythmics including disopyramide and flecainide, antipsychotic drugs, tricyclic antidepressants, fluoxetine, benzodiazepines, NSAIDs, calcium channel blockers, recent epidural analgesics, and D1 and D2 agonists for the treatment of Parkinson’s disease.² The street drug—3,4-methylenedioxy—amphetamine (MDMA or ecstasy) has also been found to be associated with AUR.^2–4