Psikotik Belirtilerin ve Nöbetlerin Eşlik Ettiği Ensefalit Hastasının Klinik Yönetimi: Olgu Sunumu

Yıl 2018, Cilt: 4 Sayı: 1, 70 - 73, 01.01.2018

Derya Arslan Taha Can Tuman Nur Özgedik Uğur Çakır Osman Yıldırım

Öz

Ensefalit baş ağrısı, ateş, mide bulantısı, kusma, bilinç durumunda dalgalanma ve uyku- uyanıklık döngüsünün bozulması gibi bulguların eşlik edebildiği, beyin dokusunun infl amasyonu ile karakterize klinik bir tablodur. Ensefalit etiyolojisinde yer alan nedenlerden biri olan otoimmunite temelli N-metil-D-aspartat NMDA reseptör ensefaliti; hastaların yaklaşık %77’sinde nöropsikiyatrik belirtilerin eşlik etmesi ve klinikte ilk başvurunun psikiyatri hekimine olması nedeniyle psikiyatrinin ilgi alanına da girmektedir. Erken dönemde müdahale edilmediği takdirde ölüm oranlarının yüksek olması sebebiyle Anti NMDA-R ensefaliti tedavisinde hedef, hem psikotik belirtilerin hem de diğer klinik durumların düzeltilmesini içermelidir. Bu olgu bildiriminde, psikotik belirtilerin ve epileptik nöbetlerin eşlik ettiği Anti-NMDAR ensefalitli hastanın, tanıdan tedaviye klinik yönetiminde dikkat edilmesi gereken etmenlerin ve bu süreçte karşılaşılan güçlüklerin ele alınması amaçlanmıştır

Anahtar Kelimeler

Anti NMDA-R Ensefaliti, Psikotik belirti, Epileptik nöbet

The Clinical Management of the Psychotic Symptoms in a Patient with Encephalitis with Seizures: Case Report

Öz

Encephalitis is an infl ammation of the brain tissue. Headache, fever, nausea, vomiting and confusion are the most common presenting symptoms of the disease. Anti N-methyl-D- aspartate NMDA receptor encephalitis is one of the autoimmune causes of encephalitis where 77% of patients suffer from neuropsychiatric symptoms. Psychiatrists are interested in Anti-NMDA-R encephalitis because it is well known that autoimmune encephalitis is associated with psychiatric symptoms. Anti NMDA-R encephalitis is associated with high rates of mortality and morbidity despite treatment. The management of the clinical features is very important in these patients because of the high rate of death in the early stages. In this paper, we aimed to report the management of the clinical features of a case with Anti NMDA-R encephalitis presenting with seizures and psychotic symptoms

Anahtar Kelimeler

Anti NMDA-R Encephalitis, Psychotic symptoms, Seizure

Kaynakça

• 1. The infections of CNS. In: Victor M, Ropper AH, eds. Adams and Victor’s Principle of Neurology. 9 th ed., New York: McGraw-Hill, 2011: 716-22.
• 2. Corey L. Herpes simplex virus. In: Mandell GL, Bennet JE, Dolin R, eds. Mandell, Douglas, and Bennet’s Principles of Infectious Diseases. 6th ed. Philadelphia: Elsevier Churchill-Livingstone, 2005: 1762-80.
• 3. Dalmau J, Gleichman AJ, Hughes EG, Rossi JE, Peng X, Lai M, Dessain SK, Rosenfeld MR, Balice-Gordon R, Lynch DR. Anti-NMDA-receptor encephalitis: Case series and analysis of the effects of antibodies. Lancet Neurol. 2008;12:1091-8.
• 4. Kruse JL, Jeffrey JK, Davis MC, Dearlove J, Ishak WW, Brooks JO. 3rd. Anti-N-methyl-D- aspartate receptor encephalitis: A targeted review of clinical presentation, diagnosis, and approaches to psychopharmacologic management. Ann ClinPsychiatry 2014;26:111–9.
• 5. Kayır H. Stahl’ın Temel Psikofarmakolojisi. Uzbay İT (çev.) 3. Baskı, İstanbul: İstanbul Tıp Kitapevi, 2012:247- 325.
• 6. Corlett PR, Honey GD, Krystal JH, Fletcher PC. Glutamatergic model psychoses: Prediction error, learning, and inference. Neuropsychopharmacology 2011;36:294–315.
• 7. Javitt DC. Glutamate and schizophrenia: phencyclidine, N-methyl-D-aspartate receptors, and dopamineglutamate interactions. Int Rev Neurobiol 2007;78:69– 108.
• 8. Lennox BR, Coles AJ, Vincent A. Antibody-mediated encephalitis: A treatable cause of schizophrenia. Br J Psychiatry. 2012;200:92–4.
• 9. Titulaer MJ, McCracken L, Gabilondo I, Armangué T, Glaser C, Iizuka T, Honig LS, Benseler SM, Kawachi I, Martinez-Hernandez E, Aguilar E, Gresa-Arribas N, Ryan-Florance N, Torrents A, Saiz A, Rosenfeld MR, Balice-Gordon R, Graus F, Dalmau J. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: An observational cohort study. Lancet Neurol 2013;12:157-65.
• 10. Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R. Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol 2011;10:63–74.
• 11. Dericioglu N, Vural A, Acar P, Agayeva N, Ismailova V, Kurne A, Saka E, Arsava EM, Topcuoglu MA. Antiepileptic treatment for anti-NMDA receptor encephalitis: the need for video-EEG monitoring. Epileptic Disord 2013;15:166-70.
• 12. Pollak TA, McCormack R, Peakman M, Nicholson TR, David AS. Prevalence of anti-N-methyl-Daspartate (NMDA) receptor antibodies in patients with schizophrenia and related psychoses: a systematic review and meta-analysis. Psychol Med 2014; 44:2475–87.
• 13. Gabilondo I1, Saiz A, Galan L, Gonzalez V, Jadraque R, Sabater L, Sans A, Sempere A, Vela A, Villalobos F, Vinals M, Villoslada P, Graus F. Analysis of relapses in anti-NMDAR encephalitis. Neurology 2011; 77:996-9.