How does viral encephalitis typically present and how is it treated?

• A. Acute altered mental status with fever and focal deficits; treated supportively and with acyclovir if HSV suspected
• B. Fever with neck stiffness only; treated with antibiotics
• C. Chronic progressive neuropathy; treated with steroids
• D. Headache only; treated with analgesics

Answer: (A)

Viral encephalitis typically presents with an abrupt onset of fever and altered mental status, often with confusion, behavior changes, or seizures, and sometimes focal neurological deficits. Because herpes simplex virus can cause rapid and devastating brain inflammation, the standard approach is to start intravenous acyclovir right away when viral encephalitis is suspected, even before confirmatory tests are back. This empiric antiviral therapy is crucial for improving outcomes if HSV is the culprit, with supportive care and diagnostic testing (like CSF analysis and HSV PCR) guiding ongoing management. Antibiotics aren’t the primary treatment unless there’s a concern for bacterial meningitis; the other patterns described—fever with neck stiffness only, chronic progressive neuropathy, or headache alone—don’t capture the typical acute encephalitic picture with altered mental status and the need for urgent antiviral therapy.