Patient presents with signs of encephalitis (altered mental status, emotional lability, fever, etc.) with CSF findings consistent with a viral infection (elevated WBC count with lymphocytic predominance, elevated protein and normal glucose), most consistent with HSV encephalitis
Fungal infection CSF: Elevated WBC count with lymphocytic predominance with decreased glucose
Bacterial infection CSF: Highly elevated WBC count (>1000) with neutrophilic predominance with decreased glucose
Normal CSF findings: WBC 0-5, Glucose 40-70 (2/3 serum glucose levels), Protein < 40
Key idea: Patients with suspected HSV encephalitis should be started on empiric IV acyclovir while awaiting PCR results and/or before brain MRI
HSV encephalitis presents with non-specific symptoms of confusion/AMS, behavior changes, and focal seizures. CSF showing mildly elevated protein and lymphocytes with xanthochromia confirms the diagnosis.
submitted by โstep_prep7(71)
- Patient presents with signs of encephalitis (altered mental status, emotional lability, fever, etc.) with CSF findings consistent with a viral infection (elevated WBC count with lymphocytic predominance, elevated protein and normal glucose), most consistent with HSV encephalitis
- Fungal infection CSF: Elevated WBC count with lymphocytic predominance with decreased glucose
- Bacterial infection CSF: Highly elevated WBC count (>1000) with neutrophilic predominance with decreased glucose
- Normal CSF findings: WBC 0-5, Glucose 40-70 (2/3 serum glucose levels), Protein < 40
- Key idea: Patients with suspected HSV encephalitis should be started on empiric IV acyclovir while awaiting PCR results and/or before brain MRI
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