neurologic disorders
Encephalitis
Treatment of Encephalitis
Supportive care Acyclovirfor HSV or varicella-zoster virus encephalitis Supportive therapy for encephalitis includes treatment of fever, dehydration, electrolyte disorders, and seizures. Euvolemia should be maintained. Because prompt identification of HSV or varicella-zoster virus by PCR is difficult, treatment should not be withheld pending confirmation by testing. Until HSV encephalitis and varicella-zoster virus encephalitis are excluded,acyclovir10 mg/kg IV every 8 hours should be started promptly and continued usually for 14 days or until infection with these viruses is excluded.Acycloviris relatively nontoxic but can cause liver function abnormalities, bone marrow suppression, and transient renal failure. GivingacyclovirIV slowly over 1 hour with adequate hydration helps prevent nephrotoxicity. If cytomegalovirus is suspected (eg, in immunocompromised patients), PCR is usually done before treatment is started. Cytomegalovirus encephalitis can be treated withganciclovirand/or other antiviral drugs. Because a bacterial central nervous system (CNS) infection is often difficult to exclude when patients who appear seriously ill present, empiric antibiotics are often given until Antibiotics is excluded. If clinicians suspect that encephalitis is caused by an immunologic reaction (eg, acute disseminated encephalomyelitis [postinfectious encephalomyelitis]), treatment should be begun immediately; it may include corticosteroids (prednisoneormethylprednisolone) and plasma exchange or IV immune globulin. 