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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 man presents with fever, headache, and confusion over 5 days. MRI shows bilateral temporal T2 hyperintensity with haemorrhage. CSF: 80 lymphocytes/µL, protein 0.8 g/L, normal glucose. HSV PCR is pending. What must happen immediately?

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Correct answer: A — Start IV aciclovir immediately

In suspected HSE, IV aciclovir must be started immediately — never delayed for PCR results. HSV PCR can be negative in the first 72 hours. A: Waiting risks irreversible damage. C: Ceftriaxone treats bacterial meningitis. D: Oral valaciclovir is inadequate. E: Repeating LP delays treatment.

Reference: ABN/BSAC Encephalitis Guidelines (2012)