To the Editor:—

We read with interest the report by Easley et al.  1of aseptic meningitis after spinal anesthesia in an infant. Although the report is a poignant reminder that this complication is a risk when performing spinal anesthesia in any patient, adult or neonate, we have several concerns. First, the differential diagnosis between viral meningitis and aseptic meningitis is, at best, difficult to make. Based on the authors description of the cerebrospinal fluid findings, diagnosis does not rule out viral meningitis. 2Second, in the concluding paragraph, the authors state that they suspected aseptic meningitis, but could not prove a causal relation. 1As illustrated in a recent report of two infants who were diagnosed with meningitis—one after and one immediately before placement of a spinal anesthetic—the onset of meningitis may be coincidentally timed with the induction of the spinal anesthetic. 3In such cases, the causal relation between aseptic meningitis and the spinal anesthetic should be a diagnosis of exclusion. We believe that viral meningitis was not ruled out in the report by Easley et al.  1 

Easley RB, George R, Connors D, Tobias JD: Aseptic meningitis after spinal anesthesia in an infant. A NESTHESIOLOGY 1999; 91:305–7
Prober CG: Infections of the central nervous system, viral meningoencephalitis, Nelson Textbook of Pediatrics, 15th edition. Edited by Behrman RE, Kliegman RM, Arvin AM. Philadelphia, WB Saunders, 1996, pp 713–6
Luz G, Buchele H, Innerhofer P, Maurer H: Spinal anaesthesia and meningitis in former preterm infants: Cause–effect? Paediatr Anaesth 1999; 9:262–4