In Reply:—

We appreciate the interest of Dr. Abouliesh et al.  1in our recent case report. We agree that it is not possible to differentiate viral meningitis from aseptic meningitis based on the cerebrospinal fluid findings and do not think that this differentiation is implied in our discussion of the case. More importantly, the suspected diagnosis of aseptic meningitis was subsequently further supported by the inability to isolate a virus from cultures of cerebrospinal fluid or from rectal and nasopharyngeal swabs. Although viral isolation may not always be possible, and the isolation of a virus is not conclusive evidence that the virus is the causative agent of meningitis, we think that this evidence strongly supports our conclusion of aseptic meningitis. Additionally, we were careful to state in the final paragraph that we could not prove a causal relation between the aseptic meningitis and the performance of the spinal anesthesia.

Easley RB, George R, Connors D, Tobias JD: Aseptic meningitis after spinal anesthesia in an infant. A NESTHESIOLOGY 1999; 91:305–7