Encephalitis
20%
1 / 5
1) What is NOT one of the minor criteria for definition of encephalitis?
Explanation :
Correct Answer: C) Acute mental status change
Acute mental status change, including decreased level of consciousness, personality change or psychiatric manifestation lasting > 24h is a Major criteria for definition of encephalitis. The other major criteria includes no alternative diagnosis to explain acute mental status change.
Minor criteria include fever (≥ 38 degrees C), seizure (new onset), focal neurological finding (new onset), CSF WBC ≥ 5, acute abnormality on brain MRI, or abnormal EEG consistent with acute neurological dysfunction.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
Correct Answer: C) Acute mental status change
Acute mental status change, including decreased level of consciousness, personality change or psychiatric manifestation lasting > 24h is a Major criteria for definition of encephalitis. The other major criteria includes no alternative diagnosis to explain acute mental status change.
Minor criteria include fever (≥ 38 degrees C), seizure (new onset), focal neurological finding (new onset), CSF WBC ≥ 5, acute abnormality on brain MRI, or abnormal EEG consistent with acute neurological dysfunction.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
40%
2 / 5
2) How many minor criteria are needed to meet the definition of encephalitis?
Explanation :
Correct Answer: D) ≥ 2
≥2 criteria in addition to the 2 major criteria are indicated for definition of encephalitis.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
Correct Answer: D) ≥ 2
≥2 criteria in addition to the 2 major criteria are indicated for definition of encephalitis.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
60%
3 / 5
3) What is NOT one of the poor prognostic features for HSV encephalitis?
Explanation :
Correct Answer: B) Seizure
Age > 30, GCS ≤ 10, extensive brain involvement on MRI, and delay in initiation of IV acyclovir are all associated with poor prognosis for HSV encephalitis.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
Correct Answer: B) Seizure
Age > 30, GCS ≤ 10, extensive brain involvement on MRI, and delay in initiation of IV acyclovir are all associated with poor prognosis for HSV encephalitis.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
80%
4 / 5
4) True or False. If there is a high clinical suspicion for herpes simplex encephalitis, intravenous acyclovir can be discontinued after the initial HSV-1 PCR test is negative, since the PCR test has high sensitivity.
Explanation :
Correct Answer: B) False
“There is universal agreement in domestic and international encephalitis guidelines that IV acyclovir should be initiated at the time of presentation and continued despite an initially negative HSV”.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
Correct Answer: B) False
“There is universal agreement in domestic and international encephalitis guidelines that IV acyclovir should be initiated at the time of presentation and continued despite an initially negative HSV”.
Reference:
Bloch KC, Glaser C, Gaston D, Venkatesan A. State of the Art: Acute Encephalitis. CID 2023; 77(5):e14-23
100%
5 / 5
5) True or False. Even if there is no CSF pleocytosis, HSV-1 PCR should be performed and intravenous acyclovir started if herpes simplex encephalitis is still a consideration and clinical suspicion is high.
Explanation :
Correct Answer: A) True
CSF pleocytosis is only 1 of 6 minor criteria and does not need to be present for the diagnosis of encephalitis. In Habis et al review, 23.7% of patients with HSV-1 encephalitis had an absence of CSF pleocytosis on initial CSF analysis.
Reference:
Habis R, Kolchinski A, et al. Absence of Cerebrospinal Fluid Pleocytosis in Encephalitis. CID 2024; ciae391
Correct Answer: A) True
CSF pleocytosis is only 1 of 6 minor criteria and does not need to be present for the diagnosis of encephalitis. In Habis et al review, 23.7% of patients with HSV-1 encephalitis had an absence of CSF pleocytosis on initial CSF analysis.
Reference:
Habis R, Kolchinski A, et al. Absence of Cerebrospinal Fluid Pleocytosis in Encephalitis. CID 2024; ciae391
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