USMLE Forum - Largest USMLE Community

A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after an episode of left arm shaking that lasted approximately 3 minutes.  Over the past 2 days, he has had fever and emotional lability.  On arrival, his temperature is 38.9 C (102 F).  He is somnolent and disoriented to person, place, and time.  He responds poorly to pain.  Neurologic examination shows no other abnormalities.  Laboratory studies show:
 

 Hematocrit 34%
 Leukocyte count 6000/mm3
 Segmented neutrophils  50%
 Lymphocytes 50%
 Platelet count 280,000/mm3
 
Analysis of cerebrospinal fluid shows:
 Leukocyte count 120/mm3
 Segmented neutrophils 20%
 Lymphocytes 80%
 Erythrocyte count 300/mm3
 Glucose 60 mg/dL
 Protein 400 mg/dL
What is the most likely cause of this patient's neurologic findings?
Bacterial or Virus?

Sounds like a viral infection. Since lymphocytes dominant.

Yeh, me too. But my question is why there is Erythrocyte count?

Because bleeding occurs inside the CNS. Infection can lead to bleeding, can't it?

This patient looks like HSV encephalitis. Is it one of your choices? RBC can be increased in CSF, plus the high lymphocyte profile. Next time, could you give the full Q please?

yes, that's right. you are excellent.

any inflamation process causes inc in ESR

He is not talking about ESR, but erythrocyte counts-RBC counts.

ok purple

Herpese encephalitis-