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Herpes Simplex Encephalitis — SCE Neurology MCQ

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EasyCNS InfectionsHerpes Simplex EncephalitisSCE Neurology

A 25-year-old man presents with fever, headache, confusion, and left temporal seizure. MRI brain shows T2/FLAIR hyperintensity and swelling in the left temporal lobe with petechial haemorrhage. CSF shows 120 lymphocytes/µL, protein 1.0 g/L, glucose 3.2 mmol/L (serum 5.5 mmol/L), and HSV-1 PCR is positive. What is the most appropriate treatment?

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Correct answer: A — Intravenous aciclovir 10 mg/kg three times daily for at least 14 days

Herpes simplex encephalitis requires urgent treatment with IV aciclovir 10 mg/kg every 8 hours for at least 14 (and up to 21) days. The characteristic presentation includes fever, encephalopathy, temporal lobe seizures, and MRI showing temporal lobe involvement. Treatment must not be delayed for investigation results. A: Ceftriaxone is for bacterial meningitis. C: Oral valaciclovir is inadequate for encephalitis. D: Dexamethasone alone does not treat the infection. E: Ganciclovir is for CMV, not HSV.

Reference: ABN/BSAC Encephalitis Guidelines (2012); BNF Aciclovir Dosing