HSV Encephalitis Case Flashcards Preview

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Flashcards in HSV Encephalitis Case Deck (15):
1

Encephalitis and meningitis often appear the same, but what are some symptoms that would clue you into encephalitis?


seizures, stupor, coma and focal neurological findigns are much more common in encephalitis

also CT changes

2

Is encephalitis more often viral or bacterial


viral

3

If the encephalitis is bacterial, what is usually the cause?


Rickettsial - RMSF, lyme, anaplasmosis, powasan

4

What lab test do you largely use to determine what virus is causing the encephalitis?


PCR

5

What is targeted in viral encephalitis compared to post-infectious encephalitis?


viral = the neurons themselves are damaged

post-infectious = neurons spared, but you get perivascular inflammation and demyelination

6

What forms of viral encephalitis are more common in the summer/fall? Winter/spring? anytime?


summer/fall - west nile, st louis encephalitis, eastern equine, california encephalitis

winter/spring - mumps, measles

any season - HSV1, HIV

7

Besides the neurological finginds, what are some clinical presentation specific tot he following:

mumps

west nile

st. louise

rabies

VSV


mumps - parotitis

west nile = flaccid paralysis and tremor of eyelids

st louis = tremor of eyelids

rabies = hydrophobia, aerophobia, throat spasms, hyperactivity

VXV = vesicles

8

WHat virus is the most commonc cause of fatal sporadic encephalitis in the US?


HSV type 1

(note HSV2 is more common worldwide andin neonates)

9

What are the three potential routes of pathogenesis for encephalitis?


1. immediate CNS invasion via the trigeminal nerve or olfactory tract

2. CNS invasion after episodes of recurrent HSV-1 infection

3. Reactivaiton of latent HSV virus within the CNS

10

Are the symptoms of encephalitis more likely to e due to cell damage from the virus or from the immune system?


the immune system

11

What would you see in CSF with a viral encephalitis?


increased WBCs with lymphocytes

increased RBCs

increased protein

Low glucose would be very uncommon in this place

12

What is the gold standard to diagnose an HSV1 encephalitis?


PCR ont he CSF looking for herpes simplex DNA

13

What sort sof imaging studies should you do if you suspect a viral encephalitis?


head CT first, but it's poorly sensitive and will often be normal in ealry disease

MRI is the most sensitive and specific for this - especially with temporal lobe abnormalities like our patient had

EEG

14

What is the empiric treatment for viral encephalitis?


IV acyclovir

15