An 18-year-old man develops fever, headache, confusion, and generalized seizures. On examination, he is moving all his limbs, but incoherent. A CT scan shows bilateral, small, low-density temporal lobe lesions. CSF shows mononuclear cell pleocytosis, increased protein, and normal glucose. The EEG shows bilateral periodic discharges from the temporal leads and slow-wave complexes at regular intervals of 2-3/sec. Which of the following is the most appropriate next step in management?
The patient's findings strongly suggest herpes simplex encephalitis. This is generally caused by herpes simplex virus type 1 (HSVI). When the disease is suspected, appropriate antiviral therapy (acyclovir) should be started immediately. CT scan is not helpful in diagnosis because it becomes positive only late in the disease, but MRI scans may be helpful. Brain biopsy, once the diagnostic test of choice, is the most definitive test but is rarely performed.
angiography
observing response to therapy
cerebral biopsy
acute viral titers
C.N.S.