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NEUROSAE 2018 ANNUAL MEETING EDITION (VOLUME 10, ISSUE 3)
QUESTION 66 OF 100
A 32-year-old man presents with a 3-day history of increasing confusion. Examination reveals he is alert and oriented to person and place only and he has some mild receptive aphasia. CSF analysis shows mild leukocytosis with lymphocytic predominance and an abundance of red blood cells. His MRI scan is shown. Which of the following medications provides the most effective therapy?
A. Foscarnet 40 mg/kg every 8 hours
B. Dexamethasone 4 mg every 6 hours
C. Acyclovir 10 mg/kg every 8 hours **
D. Doxycycline 100 mg every 12 hours
E. Ganciclovir 5 mg/kg every 12 hours
** = Your answer
Results of CSF analysis and MRI findings support a diagnosis of herpes simplex virus encephalitis for which the optimal treatment is acyclovir. Dexamethasone is indicated only as adjunctive therapy in pneumococcal meningitis. Both foscarnet and ganciclovir are used primarily in the treatment of cytomegalovirus infections. Doxycycline is not indicated for the treatment of viral meningitis.
* Greenlee JE. Encephalitis and postinfectious encephalitis. Continuum Lifelong Learning Neurol. 2012;18(6):1271-1289.