Herpes simplex encephalitis - Revision history

Aidan: /* Management */

2021-04-27T14:55:32Z

Management

← Older revision		Revision as of 14:55, 27 April 2021
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	*[[Acyclovir]] 10mg/kg q8h IV for 14 days		*[[Acyclovir]] 10mg/kg q8h IV for 14 days
	**Ensure adequate hydration and adjust for renal function		**Ensure adequate hydration and adjust for renal function
			**May do longer 14-21 days in immunocompetent patients due to high risk of relapse

	==Prognosis==		==Prognosis==

Aidan: /* Investigations */

2020-08-12T22:12:17Z

Investigations

← Older revision		Revision as of 22:12, 12 August 2020
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	**Normal or slightly low glucose		**Normal or slightly low glucose
	**'''HSV PCR''' is confirmatory		**'''HSV PCR''' is confirmatory
			**If PCR is negative but suspicion remains high, repeat LP in 3 to 7 days
	*EEG		*EEG
	**Spikes and slow waves over involved areas		**Spikes and slow waves over involved areas
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	==Management==		==Management==

			*May need repeat LP if the first one is negative but suspicion is high
	*[[Acyclovir]] 10mg/kg q8h IV for 14 days		*[[Acyclovir]] 10mg/kg q8h IV for 14 days
	**Ensure adequate hydration and adjust for renal function		**Ensure adequate hydration and adjust for renal function

	== Prognosis ==		==Prognosis==

	* 15% recover completely		*15% recover completely
	* 20% have severe neurologic sequelae		*20% have severe neurologic sequelae
	** Primarily dysnomia and impaired new learning		**Primarily dysnomia and impaired new learning
	** Also seizures, neuropsychiatric illnesses		**Also seizures, neuropsychiatric illnesses
	* 28% mortality even with treatment		*28% mortality even with treatment
	* Prognosis is worse with those who are older, are sicker at presentation, or have delayed treatment		*Prognosis is worse with those who are older, are sicker at presentation, or have delayed treatment

	[[Category:Herpesviridae]]		[[Category:Herpesviridae]]

Aidan at 22:11, 12 August 2020

2020-08-12T22:11:15Z

← Older revision		Revision as of 22:11, 12 August 2020
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	== Background ==		==Background==

	*Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes		*Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes

	=== Microbiology ===		===Microbiology===

	* More commonly caused by [[HSV-1]] than [[HSV-2]] (which more commonly causes [[aseptic meningitis]])		*More commonly caused by [[HSV-1]] than [[HSV-2]] (which more commonly causes [[aseptic meningitis]])

	=== Pathophysiology ===		===Pathophysiology===

	* About one-third are from primary infection while two-thirds are from reactivation of latent infection		*About one-third are from primary infection while two-thirds are from reactivation of latent infection

	=== Epidemiology ===		===Epidemiology===

	* Causes about 10% of [[encephalitis]] cases		*Causes about 10% of [[encephalitis]] cases

	==Clinical Manifestations==		==Clinical Manifestations==
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	*Rapidly progressing and can lead to coma		*Rapidly progressing and can lead to coma

	== Differential Diagnosis ==		==Differential Diagnosis==

	* Other causes of [[encephalitis]]		*Other causes of [[encephalitis]]

	==Investigations==		==Investigations==
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	*[[Acyclovir]] 10mg/kg q8h IV for 14 days		*[[Acyclovir]] 10mg/kg q8h IV for 14 days
	**Ensure adequate hydration and adjust for renal function		**Ensure adequate hydration and adjust for renal function

			== Prognosis ==

			* 15% recover completely
			* 20% have severe neurologic sequelae
			** Primarily dysnomia and impaired new learning
			** Also seizures, neuropsychiatric illnesses
			* 28% mortality even with treatment
			* Prognosis is worse with those who are older, are sicker at presentation, or have delayed treatment

	[[Category:Herpesviridae]]		[[Category:Herpesviridae]]

Aidan at 22:08, 12 August 2020

2020-08-12T22:08:03Z

← Older revision		Revision as of 22:08, 12 August 2020
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			== Background ==
⚫	* Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes

		⚫	*Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes
⚫	== Clinical Manifestations ==

			=== Microbiology ===
⚫	* Fever
⚫	* Headache
⚫	* Altered level of consciousness
⚫	** Personality and behavioural changes
⚫	* Focal neuro deficits
⚫	* Seizures
⚫	* Rapidly progressing and can lead to coma

			* More commonly caused by [[HSV-1]] than [[HSV-2]] (which more commonly causes [[aseptic meningitis]])
⚫	== Investigations ==

			=== Pathophysiology ===
⚫	* Imaging
⚫	** CT head usually normal
⚫	** MRI head can show T2 signal change in temporal lobes
⚫	* Lumbar puncture
⚫	** Elevated protein
⚫	** Lymphocytosis (10-1000 WBCs)
⚫	** Erythrocytes in 80% of cases ("hemorrhagic necrotizing meningoencephalitis")
⚫	** Normal or slightly low glucose
⚫	** '''HSV PCR''' is confirmatory
⚫	* EEG
⚫	** Spikes and slow waves over involved areas
⚫	** Periodic lateralized epiieptiform discharges (PLEDs)
⚫	** Usually predominately over involved termporal lobe

			* About one-third are from primary infection while two-thirds are from reactivation of latent infection
⚫	== Management ==

			=== Epidemiology ===
⚫	* [[Acyclovir]] 10mg/kg q8h IV for 14 days

⚫	** Ensure adequate hydration and adjust for renal function
			* Causes about 10% of [[encephalitis]] cases

		⚫	==Clinical Manifestations==

		⚫	*Fever
		⚫	*Headache
		⚫	*Altered level of consciousness
		⚫	**Personality and behavioural changes
		⚫	*Focal neuro deficits
		⚫	*Seizures
		⚫	*Rapidly progressing and can lead to coma

			== Differential Diagnosis ==

			* Other causes of [[encephalitis]]

		⚫	==Investigations==

		⚫	*Imaging
		⚫	**CT head usually normal
		⚫	**MRI head can show T2 signal change in temporal lobes
		⚫	*Lumbar puncture
		⚫	**Elevated protein
		⚫	**Lymphocytosis (10-1000 WBCs)
		⚫	**Erythrocytes in 80% of cases ("hemorrhagic necrotizing meningoencephalitis")
		⚫	**Normal or slightly low glucose
		⚫	**'''HSV PCR''' is confirmatory
		⚫	*EEG
		⚫	**Spikes and slow waves over involved areas
		⚫	**Periodic lateralized epiieptiform discharges (PLEDs)
		⚫	**Usually predominately over involved termporal lobe

		⚫	==Management==

		⚫	*[[Acyclovir]] 10mg/kg q8h IV for 14 days
		⚫	**Ensure adequate hydration and adjust for renal function

	[[Category:Herpesviridae]]		[[Category:Herpesviridae]]

Aidan: Text replacement - "== Presentation" to "== Clinical Manifestations"

2020-08-02T10:47:39Z

Text replacement - "== Presentation" to "== Clinical Manifestations"

← Older revision		Revision as of 10:47, 2 August 2020
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	* Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes		* Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes

	== ~~Presentation~~ ==		== Clinical Manifestations ==

	* Fever		* Fever

Aidan: /* Management */

2019-11-17T03:49:32Z

Management

← Older revision		Revision as of 03:49, 17 November 2019
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	* [[Acyclovir]] 10mg/kg q8h IV for 14 days		* [[Acyclovir]] 10mg/kg q8h IV for 14 days
	** ~~Adjust~~ for renal function		** Ensure adequate hydration and adjust for renal function

	[[Category:Herpesviridae]]		[[Category:Herpesviridae]]

Aidan: /* Management */ linkified

2019-08-17T21:18:24Z

Management: linkified

← Older revision		Revision as of 21:18, 17 August 2019
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	== Management ==		== Management ==

	* Acyclovir 10mg/kg q8h IV for 14 days		* [[Acyclovir]] 10mg/kg q8h IV for 14 days
	** Adjust for renal function		** Adjust for renal function

Aidan: /* Management */

2019-08-17T21:18:11Z

Management

← Older revision		Revision as of 21:18, 17 August 2019
Line 32:		Line 32:
	** Adjust for renal function		** Adjust for renal function

			[[Category:Herpesviridae]]
	[[Category:CNS infections]]		[[Category:CNS infections]]

Aidan: /* Management */

2019-08-17T21:17:47Z

Management

← Older revision		Revision as of 21:17, 17 August 2019
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	** Adjust for renal function		** Adjust for renal function

	[[Category:HSV]]
	[[Category:CNS infections]]		[[Category:CNS infections]]

Aidan at 10:30, 16 August 2019

2019-08-16T10:30:54Z

← Older revision		Revision as of 10:30, 16 August 2019
Line 1:		Line 1:
	* Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes		* Infection of the brain parenchyma by [[Herpes simplex virus\|HSV]], with a predilection for temporal lobes

	= Presentation =		== Presentation ==

	* Fever		* Fever
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	* Rapidly progressing and can lead to coma		* Rapidly progressing and can lead to coma

	= Investigations =		== Investigations ==

	* Imaging		* Imaging
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	** Usually predominately over involved termporal lobe		** Usually predominately over involved termporal lobe

	= Management =		== Management ==

	* Acyclovir 10mg/kg q8h IV for 14 days		* Acyclovir 10mg/kg q8h IV for 14 days