# Encephalitis (Emergency Referral) - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/ - Verified date: 2026-08 ## Verified against - Encephalitis (Emergency Referral) - disease-level clinical article (encephalitis-referral-clinical.txt) - Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/ ## Treatment metadata - Acyclovir — 250 mg — injection - Referral & safety-netting (no drug therapy) ## Complete treatment card ```text ENCEPHALITIS (EMERGENCY REFERRAL) Sources: Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/ Review status: REVIEWED against Encephalitis (Emergency Referral) - disease-level clinical article (encephalitis-referral-clinical.txt), Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/ (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Fever, headache, seizures, and altered mental status are the most common presenting features [fever · headache · seizures] - Behavioral change, hallucinations, or cognitive decline are often seen [hallucinations] - HSV encephalitis affects the temporal and frontal lobes, producing psychiatric symptoms, memory loss, and aphasia [memory loss · slurred speech] SIGNS - what you find (6) - A vesicular rash points to herpes zoster encephalitis, while lymphadenopathy and splenomegaly point to EBV [blisters · lymphadenopathy · splenomegaly · vesicles] - Choreoathetosis or parkinsonian movements suggest an arbovirus affecting the basal ganglia - Japanese encephalitis can cause extrapyramidal symptoms mimicking Parkinson disease - Enterovirus 71 encephalitis can produce ataxia, cranial nerve palsies, pulmonary edema, tremor, and myoclonus [oedema · tremor · unsteadiness] - Nipah virus can cause segmental myoclonus, hypertension, and signs referable to the brainstem and cerebellum [hypertension] - Microcephaly is characteristic of Zika virus infection [dysmorphic features] TESTS (6) - CT or MRI is done before lumbar puncture to rule out raised intracranial pressure and herniation risk - CT can show low-density temporal lobe lesions in HSV encephalitis, typically appearing 3 to 5 days after infection - MRI is the most sensitive imaging test for HSV encephalitis, showing temporal and frontal lobe involvement - CSF typically shows normal glucose, moderately elevated protein, and moderate lymphocytosis - About 10% of patients with viral encephalitis have normal CSF studies - Seizure patients may show EEG abnormalities, and Japanese encephalitis has distinctive delta or alpha-coma patterns IF NOT THIS - what else fits (6) - Malignancy - Autoimmune or paraneoplastic disease such as anti-NMDA receptor encephalitis - Brain abscess - Tuberculosis or drug-induced delirium - Neurosyphilis - Bacterial, fungal, protozoal, or helminthic encephalitis Source StatPearls "Viral Encephalitis" - disease-level clinical article Status traced to the source above Rx: Antiviral | Main treatment ANTIVIRAL 1. ACYCLOVIR [1st line] Adult 10 mg/kg intravenously every 8 hours x 14 to 21 days Peds The article states no separate paediatric or neonatal dose, and neonatal herpes simplex is dosed differently from the figure above, so none is printed. A child with suspected encephalitis goes in on the same emergency pathway and the dose comes from the admitting paediatric team. Source Viral Encephalitis - StatPearls - NCBI Bookshelf - https://www.ncbi.nlm.nih.gov/books/NBK470162/ Why The cited article states that treatment of viral encephalitis is otherwise supportive, that herpes simplex encephalitis is the very important exception, and that acyclovir started early significantly reduces death and disability and limits long-term behavioural and cognitive damage. On the strength of that it recommends starting every patient with suspected encephalitis on acyclovir empirically, and gives the dose as 10 mg/kg intravenously every 8 hours for 14 to 21 days. The Egyptian formulary chapters held here contain no acyclovir monograph, so both the indication and the dose come from that article and it is named on the row. Caution THE DRUG DOES NOT REPLACE THE TRANSFER - IT IS WHAT THE TRANSFER IS FOR. This is intravenous, inpatient treatment alongside neuroimaging and a lumbar puncture. Do not hold a patient in the clinic to give anything by mouth. START IT ON SUSPICION, NOT ON PROOF. The article's recommendation is empirical treatment of every suspected case, because the benefit of acyclovir in herpes simplex encephalitis depends on how early it is started. IMAGE BEFORE THE LUMBAR PUNCTURE where raised intracranial pressure or a risk of uncal herniation is possible. IT IS NOT THE DOSE FOR EVERY VIRUS. The same article gives 10 to 15 mg/kg every 8 hours for 10 to 14 days for varicella-zoster, with corticosteroids possibly added in an immunocompetent patient, and for cytomegalovirus a different pair of drugs entirely - ganciclovir 5 mg/kg every 12 hours with foscarnet 60 mg/kg every 8 hours or 90 mg/kg every 12 hours, for 21 days. Which of these applies is a decision for the admitting unit. Suspect encephalitis on fever, headache, altered consciousness or seizures. Egypt SUPRAVIRAN 250MG I.V VIAL GRUNENTHAL-GE... 40.00 EGP ACICLOVIR VIATRIS 250 MG 5 VIALS REIG JOFRE > ... 530.00 EGP ACIGLOTIR 250 MG LYOPH. PD. FOR IV INF. 5 VIALS GLOBAL PHARMACEUTICAL IN... 530.00 EGP ZOVIRAX 250MG 5 I.V. INF. VIAL GLAXO SMITHKLINE 910.00 EGP MAIN TREATMENT 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Immediate emergency transfer to hospital for IV acyclovir and lumbar puncture - Immediate emergency transfer Peds Immediate emergency pediatric intensive care transfer Source No dose - emergency referral pathway, no medicine given in primary care Why Encephalitis is a time-critical emergency requiring inpatient IV antiviral therapy and neuroimaging. Caution TIME-CRITICAL EMERGENCY: Do not delay transfer to administer oral antivirals in primary care. Suspect in patients with fever, headache, altered mental status, or seizures. RED FLAG - Exclude increased intracranial pressure and uncal herniation risk via neuroimaging (CT/MRI) prior to lumbar puncture. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)