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Altered Mental Status + Fever + Seizures

September 21, 2017

High Yield Review - Herpes Simplex Virus (HSV) Encephalitis: 

Case: A 30 year old female brought in by ambulance,

with a witnessed seizure. She is altered in mentation ,  

she is febrile and tachycardic. CT Head w/o contrast shows 

no acute abnormality. A lumbar puncture is performed 

and CSF analysis shows; normal opening pressure, normal glucose, Elevated Protein,  WBC of 300 , and  > 50% LymphocytesAn HSV PCR on CSF was collected and is initially negative. A FLAIR MRI was performed  --> b/l temporal lobe and frontal lobe involvement.

She was started on Acyclovir 10mg/kg q8 for 21 days. 

Case Clues - HSV Encephalitis: 

- Altered + Fever + Seizures 

- CSF --> Shows Lymphocytic Pleocytosis

- HSV PCR  was initially negative 

- MRI Findings in the temporal and frontal lobes 




Know it for the boards - HSV Encephalitis! 

- Most common presentation: Altered mental status , fever, and seizures ( or neuro abnormalities ) 

- CSF: Lymphocytic Pleocytosis 

- FLAIR MRI: Most sensitive and specific will see Temporal and Frontal Lobe abnormalities 

- HSV PCR Can initially be negative, but  then positive on repeat     LP

- Treat with Acyclovir 10mg/kg Q8 X 21 Days 



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