Approach to the Critical Patient

Immediate priorities

Airway and breathing

Neurological status

Monitoring and targets

Monitoring bundle

Escalation triggers

Immediate empiric treatment

Empiric coverage before diagnostic confirmation

Immediate consults

Consultation triggers

History

Exposure and tick history

Tick exposure context

Seasonality

Symptom progression

Prodrome phase

Neurological phase

Risk factors

Host risk factors

Important negatives

Coinfection history

Ixodes tick coinfection risk

Physical Exam

Vital signs and general appearance

Vital sign assessment

General appearance

Neurological exam

Mental status assessment

Cranial nerve exam

Motor and cerebellar exam

Meningeal signs

Fundoscopic and skin exam

Fundoscopic exam

Skin survey

Differential Diagnosis

Life-threatening encephalitis mimics

Herpes simplex encephalitis

Bacterial meningitis

Autoimmune encephalitis

Other arboviral encephalitides

West Nile virus encephalitis

Eastern equine encephalitis

La Crosse encephalitis

Jamestown Canyon virus

Other tick-borne neurological disease

Lyme neuroborreliosis

Rocky Mountain spotted fever encephalitis

Tick-borne encephalitis Europe and Asia

Non-infectious mimics

Autoimmune anti-GABA-B receptor encephalitis

Tuberculous meningitis

Cerebral vasculitis

Laboratory Tests

CSF analysis

Lumbar puncture timing and safety

Standard CSF analysis

Viral and arboviral CSF testing

Serum diagnostic testing

POWV serology

Coinfection serology

Routine and supportive labs

Complete blood count

Comprehensive metabolic panel

Coagulation studies

Blood cultures

Inflammatory markers

Diagnostic Tests

Scoring Systems

Encephalitis severity assessment

POWV specific severity stratification

Tick-borne disease risk assessment

MRI

Brain MRI with gadolinium contrast

MRI for differential diagnosis

Spinal cord MRI

CT

CT head indications

CT limitations

Ultrasound

Bedside ultrasound role in POWV encephalitis

Ultrasound limitations in POWV

Disposition

ICU admission criteria

ICU indications

Hospitalization rate

General ward admission criteria

Ward-level care indication

Consultation requirements

Mandatory consultations

Rehabilitation planning

Discharge criteria

Discharge readiness

Follow-up plan

Treatment

Empiric encephalitis treatment

Acyclovir IV empiric therapy

Empiric bacterial coverage

Tick-borne coinfection treatment

Doxycycline for Anaplasma and Lyme

Babesiosis treatment

POWV-specific supportive management

No approved antiviral therapy for POWV

Fever management

ICP management

Head positioning

Osmotic therapy

Hyperventilation

Seizure management

First-line anticonvulsants

Benzodiazepines for acute seizures

Status epilepticus refractory management

Corticosteroids

Fluid and electrolyte management

SIADH management

DVT prophylaxis

Special Populations

Pregnancy

Pregnancy considerations for POWV

Imaging in pregnancy

Treatment considerations in pregnancy

Anticonvulsant selection

Geriatric

Age-related risk

Atypical presentation

Pharmacological considerations

Disposition considerations

Pediatrics

Epidemiology in children

Pediatric clinical features

Pediatric dosing

Pediatric airway

Child protective services

Background

Epidemiology

Geographic distribution

Case frequency and trends

Mortality and morbidity

Pathophysiology

Virus characteristics

Transmission and incubation

Neurotropism and CNS injury

Therapeutic Considerations

No specific antiviral therapy approved

Immunosuppression management

Corticosteroid evidence

Diagnostic access challenges

Prevention strategies

Patient Discharge Instructions

copy discharge instructions

Diagnosis and recovery overview

Medications to continue at home

Activity restrictions

Tick prevention going forward

Warning signs to return to emergency room

Follow-up appointments

References

Guidelines and key sources

Primary references

Guideline references

Supporting references