Pediatric emergency medicine trisk 2636 2636
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helpful in ruling out nonconvulsive SE and may demonstrate specific patterns of
cerebral dysfunction as may be seen in HSV-associated encephalitis.
Presently, the treatment of non-herpes viral encephalitis is primarily supportive
and there are limited guideline-based recommendations. Children with aseptic
meningitis and mild manifestations may be followed at home, but those with
encephalitis should be hospitalized for observation and monitoring of neurologic
status, treatment of increased ICP if present, fluid restriction, and monitoring of
urine output and serum sodium because of the risk for inappropriate antidiuretic
hormone secretion. Recently published guidelines including those from the
Infectious Disease Society of America (2008) recommend the empiric use of
acyclovir for any patient with suspected encephalitis. A recent, large
epidemiologic study of pediatric encephalitis suggests that the early use of
adjunctive steroid therapy was not associated with a reduction of mortality.
FIGURE 97.1 Coronal (A ) and axial (B ) T2-weighted magnetic resonance images showing
multifocal areas of abnormal signal in the medial aspects of both temporal lobes (large arrow )
and left posterior parietal lobe (small arrows ) in a patient with herpes simplex encephalitis.
Herpes simplex poses a special problem because early diagnosis is important in
instituting effective therapy. Polymerase chain reaction testing of CSF can yield
rapid evidence of viral nucleic acid and is sensitive and specific. Imaging studies,
although less sensitive, may also be useful. Either CT or MRI may demonstrate
focal parenchymal involvement or edema of the temporal lobes ( Fig. 97.1 ). MRI
