Aseptic Meningitis and Encephalitis - Case Study - Two Febrile Headaches, One Gets Acyclovir

Two patients arrive the same night with fever and a bad headache. One is admitted on supportive care. The other needs intravenous acyclovir within the hour. A senior resident presents both cases to an attending and reasons out loud through the one finding that separates them: mental status. What you'll learn: • Why fever, headache and neck stiffness separate nothing, and altered mental status defines encephalitis • How aseptic meningitis is a negative definition, and everything still sitting in that bucket • The two routes viruses take to the central nervous system, and why herpes simplex lands in the medial temporal lobe • How to read the aseptic spinal fluid signature, a normal glucose beside a raised protein and a lymphocyte predominant pleocytosis • When PCR, MRI and EEG help, and why acyclovir starts at the lumbar puncture rather than after the result Key takeaway: You can always stop a drug, but you cannot give back a temporal lobe. ⏱ Chapters: 0:00 Tobias, day one to day five: fever, word finding failure, then a seizure at work 4:00 Priya in late August: stiff neck, photophobia, and a completely clear sensorium 7:19 Emptying the aseptic bucket: haematogenous versus neuronal spread and the full etiology list 10:39 Reading the fluid: lymphocytic pleocytosis, normal glucose, mildly raised protein 13:32 Herpes PCR, temporal lobe MRI, EEG, and empiric acyclovir at ten milligrams per kilogram 16:25 Both plans side by side, and the five pitfalls that are thinking errors Part of Teaching Service — Hospital Rounds: education for residents and advanced practice providers. For clinician and trainee education only. Not medical advice; verify against current guidelines and institutional protocols before applying to patient care. #AsepticMeningitis #Encephalitis #HerpesEncephalitis #CaseStudy #LumbarPuncture #CerebrospinalFluid #Acyclovir #Neurology #InfectiousDisease #InternalMedicine