HSV encephalitis

This patient's presentation is consistent with viral encephalitis. The majority of acute viral encephalitis cases are due to unknown causes. However, herpes viruses (eg, herpes simplex, varicella, Epstein-Barr) most commonly cause encephalitis in immunocompetent adults. Patients typically present with fever, altered mental status, agitation, headaches, and seizures that can rapidly progress to complete unresponsiveness or coma. Examination can show neurologic abnormalities, including hemiparesis, cranial nerve palsies, and exaggerated deep-tendon reflexes. Clinical signs of meningeal irritation (eg, photophobia, nuchal rigidity) are usually absent in patients with pure encephalitis.

Lumbar puncture usually shows cerebrospinal fluid (CSF) findings of elevated white blood cell count with lymphocytic predominance, normal glucose, and normal to slightly elevated protein concentration (generally 100 mg/dL). Most patients have an increased red blood cell count as well. Diagnosis is usually confirmed by detecting viral DNA by polymerase chain reaction (PCR) in the CSF. Empiric treatment with intravenous acyclovir should be started while awaiting PCR results as encephalitis is often associated with significant morbidity and mortality.

Look for MRI findings of temporal lobe enhancement/infarct

Encephalopathy
encephalopathy
Wernecke Korsakoff

Wernicke encephalopathy (WE) is a life-threatening disorder of thiamine deficiency seen most commonly in patients with heavy alcohol use and/or severe malnutrition. The classic features of WE include:
- Encephalopathy - disorientation and confusion
- Oculomotor dysfunction - lateral rectus palsy
- Gait ataxia -
HSV
HSV
- related: HSV, HSV encephalitis
The most likely diagnosis in this patient is meningitis caused by herpes simplex virus (HSV) type 2. Viral meningitis is the most common cause of “aseptic” meningitis, in which cerebrospinal fluid (CSF) Gram stain and cultures are negative. Most patients have typical meningitis symptoms, such as fever, nuchal rigidity, headache, and photophobia. HSV meningitis syndromes can be related to

HSV encephalitis

encephalopathy

Wernecke Korsakoff

HSV