A 19-year-old student presents with 4 days of fever, behavioral change, and two witnessed focal seizures with oral automatisms. MRI shows asymmetric signal change and hemorrhagic involvement of both medial temporal lobes. CSF PCR result will take 48 hours. What is the most appropriate immediate management?
- A Wait for PCR positivity before starting antiviral therapy
- B Start intravenous acyclovir now and continue pending PCR result ✓
- C Start intravenous ganciclovir
- D Start high-dose corticosteroids alone
Correct answer: B. Start intravenous acyclovir now and continue pending PCR result
Explanation
Fever with temporal lobe seizures and medial temporal lobe signal change is herpes simplex encephalitis until proven otherwise, and empiric intravenous acyclovir must be started immediately because delay in treatment markedly worsens outcome; it is continued if PCR confirms HSV. Ganciclovir covers CMV, which causes ventriculoencephalitis in immunocompromised patients, not this classic presentation. Steroids alone have no role as definitive therapy.
Reference: Adams and Victor's Principles of Neurology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.