Supportive management

Although early delivery of acyclovir results in improved outcome from herpes simplex encephalitis, morbidity and mortality remain high. Patients who present for medical attention with stupor or coma have a mortality rate of approximately 25 per cent and a very poor prognosis for good functional recovery whether or not acyclovir is administered. A substantial number of these individuals succumb to secondary brain injury. Factors likely to produce additional morbidity by secondary injury mechanisms include severe cerebral edema with attendant elevation of intracranial pressure (ICP), incarceration of major vessels (e.g. posterior cerebral artery at the tentorial hiatus), and compromised oxygen delivery to the brain secondary to hemodynamic and/or pulmonary dysfunction. A consistent program of medical management aimed at reducing secondary injury may improve an individual's chances of good functional recovery. In addition to the foundations of supportive care necessary for any critically ill patient, a number of specific points deserve additional emphasis.

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