What is included in the initial emergency department (ED) care for encephalitis?

Updated: Aug 07, 2018
  • Author: David S Howes, MD; Chief Editor: Barry E Brenner, MD, PhD, FACEP  more...
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In the emergency department (ED), beyond supportive care, viral encephalitides are not treatable, with the exceptions of HSV and VZV encephalitis. Important initial measures include the following:

  • Administration of the first dose or doses of acyclovir, with or without antibiotics or steroids, as quickly as possible; the standard for acute bacterial meningitis is initiation of treatment within 30 minutes of arrival

  • Consideration of an ED triage protocol to identify patients at risk for HSV encephalitis

  • Collection of laboratory samples and blood cultures before the start of IV therapy

  • Neuroimaging (eg, MRI or, if that is unavailable, contrast-enhanced head CT) before LP

Additional treatment considerations include the following:

  • Management of hydrocephalus and increased ICP

  • Treatment of systemic complications (eg, hypotension or shock, hypoxemia, hyponatremia, and exacerbation of chronic diseases)

  • Empiric treatment of HSV meningoencephalitis and VZV encephalitis

Clinical practice guidelines for treatment of encephalitis have been published by the Infectious Diseases Society of America (IDSA). [1]

See Treatment and Medication for more detail.

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