G04.90 — Encephalitis
Approved24F · admission — IV aciclovir with ICU monitoring
Insurer Rationale
The requested ICU-level management and empiric antiviral therapy are approved given acute neurological deterioration and suspected encephalitis.
Reasoning Chain
This is exactly the kind of emergency escalation insurers should not block. Falling consciousness, fever, seizures, and acute confusion justify immediate antiviral treatment and close monitoring while the diagnostic pathway proceeds.
Reasoning Chain
Findings
Fever, Confusion, Generalised seizure, GCS falling to 10, Headache
Diagnosis
Encephalitis (strongly suspected)
Assessment
Acute neurologic deterioration review — Life-threatening encephalitis cannot wait for confirmatory testing before treatment begins.
Guideline action
Immediate IV aciclovir plus ICU-level observation while definitive testing proceeds
Verdict
Approval is clinically correct because early antiviral therapy is time-critical in suspected HSV encephalitis.
Clinical Evidence
Association of British Neurologists / British Infection Association Encephalitis Guideline (2024)
Empiric antiviral treatment
IV aciclovir should begin immediately when HSV encephalitis is suspected, before confirmation is complete.
NICE Guideline on Suspected CNS Infection
Emergency management
Reduced consciousness and seizures justify escalation to critical care monitoring during initial management.