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HSE – Do Not Delay Aciclovir — SCE Neurology MCQ

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EasyCNS InfectionsHSE – Do Not Delay AciclovirSCE Neurology

A 55-year-old immunocompetent man presents with fever, headache, and progressive confusion over 5 days. MRI brain shows bilateral asymmetric temporal lobe T2/FLAIR hyperintensity with haemorrhagic changes. CSF shows lymphocytic pleocytosis (80 cells/µL), protein 0.8 g/L, and normal glucose. HSV PCR is pending. What is the single most important action?

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Correct answer: A — Start IV aciclovir immediately

In suspected herpes simplex encephalitis, IV aciclovir (10 mg/kg 8-hourly) must be started immediately — treatment must never be delayed for PCR results. HSV PCR can be negative in the first 72 hours of symptoms, and a negative early result does not exclude the diagnosis. A: Waiting for PCR risks irreversible brain damage and death. C: Ceftriaxone treats bacterial meningitis, not viral encephalitis. D: Oral valaciclovir is inadequate for encephalitis. E: Repeating the LP delays treatment.

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