> For herpes encephalitis, MRI is debatable because I’m curious kind of institution you’re at? Everywhere I’ve been (NE) it’s fallen down academic lines: adver

> For herpes encephalitis, MRI is debatable because I’m curious kind of institution you’re at? Everywhere I’ve been (NE) it’s fallen down academic lines: adverse impact of unneeded antiviral tx vs. mortality benefit in hsv encephalitis is incredibly one-sided, and time sensitive. Academic tertiary care institutions basically considered it borderline malpractice not to just initiate antivirals and d/c later. Non-academic secondary care institutions agreed in theory, but basically only started antivirals if everything else was off the table and/or imaging was characteristic (aka, either too damn late or later than it should be), but cases were rare enough it didn’t mean much in practice.