The British Infection Society and Association of British Neurologists published joint guidelines in 2012 for the management of encephalitis. We wanted to audit our practice. We analysed data from discharge summaries of 150 patients admitted to St George’s Hospital who underwent a lumbar puncture (LP) between March-December 2017. We identified 30 patients with suspected encephalitis. Time to LP was 30.47 ± 6.98 hours. Opening pressure was documented in 14/30(46.6%) whereas paired serum glucose was sent in 6/30(20%) cases. Neuroimaging was performed prior to lumbar puncture with a mean time of 7.68 ± 3.93 hours in 26/30 (86.6%) cases, 16 (61.5%) of whom had a clear indication with focal neurological signs and/or low Glasgow coma score (GCS) (no documentation of ophthalmoscopy was found). Time to acyclovir administration was 10.43 ± 4.01 hours. Repeat LP after 24 hours was performed in 3/30(10%) cases. Viral PCR was performed in 27/30(90%) cases; 3/30(10%) cases were HSV-1 positive. MRI scan done in 12/30(40%) cases.

We recommend a clear protocol for clinicians to improve timeliness and completeness of the workup of suspected viral encephalitis.