Which cerebrospinal fluid (CSF) findings indicate 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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Acutely, a typical “viral profile” is identified. Red blood cells (RBCs) and xanthochromia may be seen. Patients typically have mononuclear pleocytosis of 10-500 white blood cells (WBCs)/µL (average, 100 WBCs/µL). As a result of the hemorrhagic nature of the underlying pathologic process, the RBC count may be elevated (10-500/µL). Protein levels are elevated to the range of 60-700 mg/dL (average, 100 mg/dL). Glucose values may be normal or mildly decreased (30-40 mg/dL).

In about 5-10% of patients, especially children, initial CSF results may be normal. [35] However, on serial examinations, the cell counts and protein values increase.

Viral cultures of CSF are rarely positive and should not be relied on to confirm the diagnosis. However, HSV can be cultured from the CSF in about one third of affected neonates.

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