Neurology: herpes simplex encephalitis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Neurology: herpes simplex encephalitis

Sample item

A 35-year-old man has had fever, headache and behavioural change for three days, followed by a focal seizure. MRI shows left temporal lobe hyperintensity, and CSF shows lymphocytic pleocytosis with red blood cells and raised protein. What is the most appropriate next step?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Start intravenous aciclovir immediately

Fever with behavioural change, seizures and temporal lobe involvement suggests herpes simplex encephalitis. Mortality is very high without treatment, so intravenous aciclovir is started empirically at once and continued for 14 to 21 days, and PCR of CSF confirms the diagnosis. Delay worsens outcome.

Option by option

  • A. Give pulse intravenous methylprednisolone

    Immunosuppression without antiviral cover could worsen an untreated viral infection.

  • B. Wait for CSF HSV PCR before treating

    Waiting for PCR delays life-saving therapy.

  • C. Start intravenous ceftriaxone alone

    Antibacterials alone do not treat a viral encephalitis.

  • D. Start intravenous aciclovir immediately (correct)

    Early aciclovir greatly improves survival and neurological outcome, and should not await the result.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Start intravenous aciclovir immediately. Fever with behavioural change, seizures and temporal lobe involvement suggests herpes simplex encephalitis.

Why is "Give pulse intravenous methylprednisolone" not the answer?

Immunosuppression without antiviral cover could worsen an untreated viral infection.

Why is "Wait for CSF HSV PCR before treating" not the answer?

Waiting for PCR delays life-saving therapy.

Why is "Start intravenous ceftriaxone alone" not the answer?

Antibacterials alone do not treat a viral encephalitis.

What concept does this question test?

It tests Neurology: herpes simplex encephalitis in General Medicine. Mortality is very high without treatment, so intravenous aciclovir is started empirically at once and continued for 14 to 21 days, and PCR of CSF confirms the diagnosis. Delay worsens outcome.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neurology: herpes simplex encephalitis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.