Mehl. UW herpes simplex encephalitis 04-02 (2) Flashcards
Mehl. HSV 1/2 encephalitis. CP? 2
high fever + confusion.
Mehl. HSV 1/2 encephalitis. transmission?
Herpes encephalitis can occur following vertical transmission.
Mehl. HSV 1/2 encephalitis. Why RBC in CSF?
RBCs in the CSF due to temporal lobe hemorrhage.
Mehl. HSV 1/2 encephalitis. What is the result of non-contrast CT?
Non-contrast CT of the head is often negative, so don’t be confused by this. However they can say EEG shows abnormal spikes over the temporal region.
Mehl. HSV 1/2 encephalitis. CSF findings?
Other CSF findings same as viral meningitis.
Mehl. HSV 1/2 encephalitis.
I’ve only ever seen one NBME Q on 2CK Neuro CMS form where RBCs were absent in CSF in herpes encephalitis, but you could still get the answer because other CSF findings were viral + no other virus listed.
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UW. HSV encephalitis. table. CP? 5
fever, headache, seizure, altered mental status (confusion, agitation); +/- focal neurologic findings (hemiparesis, cranial nerve palsies, ataxia)
UW. HSV encephalitis. table. CSF analysis?
incr. WBC (incr. lymphocytes), incr. RBC
incr. protein, normal glucose
HSV DNA on PCR
UW. HSV encephalitis. table. MRI?
temporal lobe hemorrhage/edema
UW. HSV encephalitis. table. Tx?
IV acyclovir
UW. HSV encephalitis. symptoms onset?
Symptoms develop acutely (over <1 week), and seizure with fever is a common presentation.
UW. HSV encephalitis.
A common cause of viral encephalitis is herpes simplex virus (HSV).
Arising from what?
Arising from either primary or reactivated infection.
UW. HSV encephalitis. spread?
Spread of primary infection likely occurs via the olfactory bulb to the olfactory cortex (within the temporal lobe) whereas reactivated HSV spreads from the trigeminal ganglion (where HSV typically remains dormant) to the adjacent temporal lobe. Therefore, temporal lobe abnormalities on imaging, such as hemorrhage or edema, are highly suggestive of HS
UW. HSV encephalitis. While awaiting confirmatory testing, empiric intravenous acyclovir should be started for suspected HSV encephalitis due to significant morbidity and mortality of untreated disease.
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