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Encephalitis — SCE Acute Medicine MCQ

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ModerateAcute Neurological PresentationsEncephalitisSCE Acute Medicine

A 56-year-old woman is assessed on the acute medical unit. She has fever, confusion, personality change and focal seizures. CT head is normal and lumbar puncture is planned. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Start intravenous aciclovir while awaiting CSF PCR

Fever, personality change and focal seizures are classic for HSV encephalitis. Intravenous aciclovir must begin immediately while CSF PCR and MRI are arranged; a normal CT does not exclude encephalitis. Dose adjustment for renal function and hydration reduce crystal nephropathy risk.

Reference: https://pmc.ncbi.nlm.nih.gov/articles/PMC5606463/