When encephalitis becomes a life-threatening condition complicated by cerebral swelling and raised ICP, pharmacological doses of corticosteroids are a reasonable intervention. Steroid agents are particularly effective in retarding the formation of vasogenic edema, which is a probable source of pathological brain bulk in many forms of severe encephalitis. It should be noted that initiation of antiparasitic medication may cause an intensification of cerebral swelling as material from dying organisms provokes an inflammatory response. Dexamethasone (10 mg intravenously initially followed by 4-6 mg every 6 h intravenously or the same dose enterally) is the agent of choice. In cases of toxoplasma encephalitis, when a diagnostic/therapeutic trial of treatment is undertaken rather than a brain biopsy, it is important not to confuse interpretation of the therapeutic response by using corticosteroids.

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