Archive Of Standardized Exam Questions: Herpes Encephalitis


This page is dedicated to organizing various examples of standardized exam questions whose answer is herpes encephalitis. While this may seem a odd practice, it is useful to see multiple examples of how herpes encephalitis will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.


Question # 1

A 15 year old girl is brought to the hospital 4 hours after a 4 minute generalized tonic clonic seizure occurs at a party. Her symptoms all started with bizarre behavior. She has had a low-grade fever and cough for 3 days. When she arrives she is arousable but is confused. She is unable to answer questions appropriately, but cannot follow commands. Her temperature is 102.2°F. Her exam shows mild resistance to neck flexion. Her deep tendon reflexes are brisk in all extremities, and the Babinski sign is present bilaterally. A non-contrast CT scan of the head shows mixed areas of hyerdensity/hypodensity int he right temporal lobe. A CSF analysis is shown below:

  • Glucose: 60 mg/dL
  • Protein: 45 mg/dL
  • Leukocyte count: 35/mm³
  • Segmented neutrophils: 18%
  • Lymphocytes: 78%
  • Erythrocyte count: 1300/mm³

What is the likely diagnosis?

Explanation: seizures + fever + hyperreflexia + CT scan showing temporal signal + erythrocytes in the CSF = herpes encephalitis


Page Updated: 11.06.2016