RT Journal Article
SR Electronic
T1 Management of suspected herpes simplex virus encephalitis in adults in a UK teaching hospital
JF Clinical Medicine
JO Clin Med
FD Royal College of Physicians
SP 231
OP 235
DO 10.7861/clinmedicine.9-3-231
VO 9
IS 3
A1 David J Bell
A1 Ruth Suckling
A1 Michael M Rothburn
A1 Tom Blanchard
A1 David Stoeter
A1 Benedict Michael
A1 Richard PD Cooke
A1 Rachel Kneen
A1 Tom Solomon
YR 2009
UL http://www.rcpjournals.org/content/9/3/231.abstract
AB The outcome of herpes simplex virus (HSV) encephalitis is improved with prompt initiation of aciclovir treatment. Delays are common, but there is little understanding of why they occur. The case notes of 21 adults admitted with suspected HSV encephalitis over one year were reviewed. The median (range) duration of illness was 2.5 (1–99) days. Seventeen (81%) patients had a lumbar puncture (LP) performed, at a median (range) time of 24 (2–114) hours after encephalitis was suspected. Lumbar puncture was delayed for a computed tomography (CT) scan in 15 patients, but only one of these had contraindications to an immediate LP. The median (range) time from presentation to starting aciclovir was 48 (2–432) hours. HSV-PCR (polymerase chain reaction) was requested on cerebrospinal fluid from 12 patients, one of whom was positive. Five (24%) patients were given the wrong dose of aciclovir. Overall the management of suspected HSV encephalitis was often sub-optimal, with delays in LP occurring due to unnecessary CT scans, and the wrong aciclovir dose administered. Guidelines for the management of suspected encephalitis are needed.