7/20/16 AM Report: HSV Encephalitis

CSF Studies:
Normal Bacterial Meningitis Viral Meningitis Fungal/TB
Opening Pressure (cm H2O) < 15 ↑↑ Normal/mild ↑ Variable
Protein (mg/dL) 15-45 Normal/mild ↑
Glucose (mg/dL) 40-70 Normal
WBC 0-8 ↑↑ (>1000) ↑ (5-300)
WBC differential Even >80% PMNs >50% Lymphs, <20% PMNs 50-80% Lymphs
Gram Stain Normal 60-90 % + N/A 37-87% AFB +

Differentiate between meningitis and encephalitis:

Brain function: abnormalities of brain function expected with encephalitis: AMS, motor/sensory deficits, speech/movement disorders

*distinction frequently blurred – meningioencephalitis both parenchymal and meningeal process.

Kernig Sign: inability/reluctance to allow full extension of the knee when hip is flexed at 90 degrees.

Brudzinski Sign: spontaneous flexion of the hip during attempted passive flexion of the neck.


*5% sensitivity and 95% specificity!


Characteristic MRI patterns for encephalitis:

  • HSV – temporal distribution
  • WNV – thalamic distribution
  • MS – periventricular (Dawson’s fingers)

Mallaret’s Meningitis: >3 recurrent episodes of HSV2 meningitis

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