FIG 2.

Hypothetical management of patients suffering from HSE with acyclovir and adjunctive corticosteroid therapy. At admission, a clinical evaluation of the patients should be performed together with laboratory testing of the cerebrospinal fluid (CSF), magnetic resonance imaging (MRI), and electroencephalography (EEG). The level of production of a reliable biomarker of inflammation in the CSF or serum should be determined. Empirical intravenous acyclovir should be initiated pending results of CSF and MRI testing and continued for 14 to 21 days if the PCR is positive. Adjunctive corticosteroid therapy should be started later, during the rise of the inflammatory response, and should be limited in time to prevent undesired effects. This combined therapy should reduce both the viral load (dotted blue line) and the excessive inflammatory response (dotted red line) and result in less damage to the brain.