NCCEd: Neurocritical Care Education for Residents

You start IV vancomycin (targeting a trough level of 15-20), ceftriaxone 2g q12h, ampicillin 2g q4h, and acyclovir 10mg/kg q8h. You opt to perform an LP first, sending off cell count and differential, protein, glucose, Gram stain and culture, HSV PCR. You also obtain an MRI of his brain once it's clinically safe to do so.

MRI brain (FLAIR)

1/18

2/18

3/18

4/18

5/18

6/18

7/18

8/18

9/18

10/18

11/18

12/18

13/18

14/18

15/18

16/18

17/18

18/18

▲ ▼

You are now very concerned that he truly has an infectious meningoencephalitis.