Recognize the manifestations and appropriate treatment of herpes simplex viral meningoencephalitis.

Explanation:

Herpes Simplex Meningo-encephalitis can be a fatal disease. Even if treated adequately it may leave behind sequelae. Worse the mental status at the onset of treatment- worse the sequelae. So initiate treatment empirically. In the past Acyclovir was a highly toxic drug but its refined forms that are currently in use are not as harmful.

As soon as you see a patient with altered mental status and fever with a focal seizure- bells should start ringing for HSV or cerebral Abscess.

Fever with a change in mental status or neck stiffness is an indication for LP in any patient.

A CT is indicated only if there are Focal findings e.g. weakness of only one arm or leg etc.

Gold standard for its diagnosis is PCR for HSV performed on CSF. MRI or CT with contrast will localize the disease to the temporal lobes. Treatment is with IV Acyclovir. Obviously the patient has to be admitted to a monitored setting.