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Herpes simplex encephalitis — RACP Paediatrics MCQ

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HardNeurology and neurodevelopmentHerpes simplex encephalitisRACP Paediatrics

A 7-year-old has fever, headache and two focal seizures. He is confused between seizures and has subtle right arm weakness. CSF shows lymphocytosis and mildly raised protein; MRI shows temporal lobe signal change. What is the most appropriate management?

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Correct answer: E — Start intravenous aciclovir immediately with empirical antibacterial cover

Temporal lobe encephalitis with fever, focal seizures and altered cognition is herpes simplex encephalitis until proven otherwise. Intravenous aciclovir should be started promptly because PCR confirmation may be delayed. Bacterial meningitis cover is usually given while the diagnosis is being clarified.

Reference: RCH Meningitis and encephalitis guideline; Therapeutic Guidelines (eTG)