Reversible Dysfunction of the Sinus Node during Acute Phase of Aseptic Meningitis

A fifty-two-year-old man who had reversible, severe dysfunction of the sinus node during acute phase of aseptic meningitis is reported. A diagnosis of aseptic meningitis was made on the basis of following clinical findings ; moderately high fever, meningeal signs and abnormalities of cerebrospinal fluid such as high pressure, an increase in white cell count, high protein content and negative culture of the fluid for bacteria, mycobacteria and fungi. During the acute phase of aseptic meningitis the patient developed marked sinus brabycardia with sinoatrial block and sinus arrest causing dizziness. The sinus rate began to increase gradually and sinoatrial block and sinus arrest disappeared as the clinical manifestations of aseptic meningitis subsided. The sinus rate was significantly raised by intravenous administration of atropine (1.0 mg). During the recovery phase of aseptic meningitis with normal pressure of cerebrospinal fluid, overdrive suppression test revealed normal values of the sinus node recovery time and the patient was in normal sinus rhythm at a rate of 60 to 70 beats/min. It is assumed that increase in the vagal tone resulted from a high intracranial pressure during the acute phase of aseptic meningitis may play an important role in the genesis of severe sinus node dysfunction in this patient.