It’s a typical busy Saturday night in the main ER, with your alcoholics and K2-smokers causing a ruckus, when you pick up a 32yo woman brought in by her friend for ‘acting strange.’ You think maybe she joined the K2-bandwagon of Brooklyn, but her friend adamantly denies any drug use, saying that she prefers sex to drugs & rock’n’roll. You get more history from her friend, who says she has been very confused, thinks it is 1976, and is having difficulty expressing herself in the last 2 days. She has no psychiatric or medical history but her friend her blurts out, “Oh, she did have a nasty blister on her lip last week”
You glance her vitals: T 100.3, otherwise normal. Exam is relatively unremarkable except for nuchal rigidity and the neuro findings mentioned by her friend.
What's the most likely diagnosis?What do you want to do next?
What do you expect to see in the CSF?
1. Mildly elevated WBC with lymphocyte predominance 2. normal glucose 3. slightly elevated protein  4. normal opening pressure
Ultimately, diagnosis is made by viral culture or PCR
Treatment?
What other viruses cause encephalitis?
Tintinalli’s 7th Ed.
Uptodate
By Dr. Kylie Birnbaum
Special thanks to Dr. Willis
Kylie Birnbaum
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