When should treatment be initiated for herpes simplex encephalitis (HSE)?

Updated: Jul 17, 2018
  • Author: Wayne E Anderson, DO, FAHS, FAAN; Chief Editor: Niranjan N Singh, MBBS, MD, DM, FAHS, FAANEM  more...
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In suspected herpes simplex encephalitis (HSE), the workup must be initiated rapidly and should not delay treatment. General laboratory studies are not helpful in diagnosis but may show evidence of infection or detect renal disease (in which case treatment must be adjusted). A high index of suspicion is required in all immunocompromised patients with febrile encephalopathy.

No pathognomonic clinical findings are associated with HSE. Focal neurologic deficits, cerebrospinal fluid (CSF) pleocytosis, and abnormalities on computed tomography (CT) scanning may be absent initially. The diagnosis can be confirmed only by means of polymerase chain reaction (PCR) or brain biopsy.

Diagnostic modalities for neonatal HSE are similar to those for HSE in older children and adults.

Go to Imaging in Herpes Encephalitis for complete information on this topic.

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