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Old 01-12-2012
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Neuro Headache, Fever, and Seizure

A 57-year-old man is brought to the emergency department after having had a seizure. His wife states that two days ago, he began complaining of a headache and fever and was intolerant to bright light. This morning she noticed he was confused and disoriented. He subsequently developed a tonic-clonic seizure. He has no past medical history and is on no medications. His temperature is 101.2 F, heart rate is 97/min, and blood pressure is 128/85 mm Hg. His pupils are equal and reactive, with normal fundi. There is marked nuchal rigidity.

Upon physical examination, the patient appears confused and disoriented with intact cranial nerves. The lumbar puncture on the day of admission shows a lymphocytic pleocytosis of the cerebrospinal fluid. Gram stain shows no organisms. The patient is then placed on intravenous acyclovir. Later, during the course of this admission, an MRI of the brain shows increased signal uptake of the right temporal lobe. Final analysis of the cerebral spinal fluid (CSF) shows no growth on bacterial or acid-fast cultures. The VDRL and CSF herpes-antibody test are negative. Which of the following is the next best step in the treatment of this patient?

(A) Brain biopsy
(B) Continue the full course of acyclovir and await PCR testing of the CSF
(C) Continue acyclovir and add ceftriaxone
(D) Discontinue acyclovir and start ceftriaxone
(E) Examine CSF for anti-HSV antibodies in four weeks
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Old 01-13-2012
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(B) Continue the full course of acyclovir and await PCR testing of the CSF

temporal lobe > HSV type1 in adult
HSV type 2 in neonate in +ve mother with vaginal delivery
starting acyclovir from 1st 2 days improve the outcome after +ve PCR the dose should be the highest dose
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Old 01-13-2012
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the ans is B...
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Old 12-30-2013
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Default Thanks....

Thanks; explanation concise and to the point. I almost got thrown off by Answer C after narrowing down the options to B & C.

Quote:
Originally Posted by fadi551 View Post
(B) Continue the full course of acyclovir and await PCR testing of the CSF

temporal lobe > HSV type1 in adult
HSV type 2 in neonate in +ve mother with vaginal delivery
starting acyclovir from 1st 2 days improve the outcome after +ve PCR the dose should be the highest dose
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