Acute Encephalitis

Focused

Step 1: View clinicals

A 50 year old man presents immediately after a left sided focal seizure which lasted for 10 minutes. He complains of feeling lethargic recently, and of having a 'mild flu'. He also experienced a mild headache a few hours prior to the onset of the seizure. There is no history of head trauma, while his medical and family histories are unremarkable. He only drinks socially. There is no history of recent foreign travel or contact with animals. A full blood count, serum electrolyte assay and arterial blood gas assay are normal.


Step 2: Order all relevant investigations

Capillary Blood Glucose

162 mg/dL (150 - 200 mg/dL)

MRI brain

There is focal edema in both temporal lobes and the orbital surfaces of both frontal lobes. There is no midline shift; no space occupying lesions are seen.

Lumbar Puncture

Appearance: Clear Polymorphonuclear cells: Nil Mononuclear cells: 34/mm3 (< 5) Glucose: 96 mg/dL (> 1/2 of blood glucose) Protein: 0.6 g/L (0.2 - 0.4) Gram stain: no organisms Culture reports: Available in 3 days. PCR: positive for HSV

EEG

The EEG shows generalized slow wave patterns.


Step 3: Select appropriate management

Corticosteroids
Acyclovir
Cephalosporins
Sedatives


Score: ★★☆