HSV Ensefalitinin Neden Olduğu Anti-NMDAR Ensefaliti Olguları: İki Farklı Klinik Seyir ve Prognoz

Öz

Herpes simpleks virüs ensefaliti (HSVE) sonrası semptomların tekrarlaması veya yeni klinik bulguların ortaya çıkması, aynı viral etkenin nüksü, yeni bir enfeksiyöz ensefalit gelişimi veya otoimmün ensefalit ile ilişkili olabilir. Olguların semptomları, klinik seyri ve elektrofizyolojik bulgularındaki farklılıklar prognozdaki farklılıklarla ilişkili olabilir. Burada sunduğumuz HSVE sonrası gelişen anti-N-metil-D-aspartat reseptör ensefaliti (anti-NMDARE) ile ilgili ilk olguda, epileptik nöbetler gözlenmiş ve elektroensefalografide (EEG) artı modifikatörlü lateralize periyodik deşarjlar (LPD) tespit edilmiştir. Takip sırasında status epileptikus gelişmiş, hasta tedaviye yanıt vermemiş ve hayatını kaybetmiştir. Buna karşılık, HSVE sonrası gelişen ikinci anti-NMDARE olgusu psikiyatrik semptomlarla başvurmuş, olgunun EEG’sinde monomorfik künt delta paterninde LPD’ler gözlemlenmiştir. Bu hasta birinci basamak tedavilere hızla yanıt vermiş ve hafif bilişsel bozukluk ile iyileşme sağlamıştır. Klinik seyir ve sonuçlardaki farklılıkların altında yatan patojenik süreçler henüz net değildir ve daha fazla araştırmaya ihtiyaç duyulmaktadır. HSVE nüksü, beyin omurilik sıvısının polimeraz zincir reaksiyonu testi ile dışlandıktan sonra, kötü prognostik göstergelere sahip hastalarda immünoterapinin erken başlatılması kritik öneme sahiptir.

Anahtar Kelimeler

• Herpes simpleks virüs ensefaliti
• otoimmün ensefalit
• lateralize periyodik deşarjlar
• anti-NMDAR ensefaliti

Cases of Anti-NMDAR Encephalitis Caused by HSV Encephalitis: Two Different Clinical Courses and Prognosis

Öz

The recurrence of symptoms or the emergence of new clinical findings following herpes simplex virus encephalitis (HSVE) can result due to the relapse of the same viral agent, development of a new infectious encephalitis or autoimmune encephalitis. Differences in the presentation, clinical course, and electrophysiological findings of cases may be associated with variations in prognosis. In the first case of anti-N-methyl-D-aspartate receptor encephalitis (anti-NMDARE) following HSVE that we presented here, the patient exhibited epileptic seizures, and electroencephalography (EEG) revealed lateralized periodic discharges (LPDs) with plus modifiers. During the follow-up, status epilepticus developed and the patient did not respond to treatment and died. In contrast, the second case of anti-NMDARE following HSVE presented with psychiatric symptoms. EEG revealed LPDs in the form of a monomorphic blunt delta pattern. This patient responded rapidly to first-line treatments and achieved recovery with mild cognitive impairment. The pathogenic processes underlying the differences in clinical course and outcomes remain unclear, emphasizing the need for further research. Early initiation of immunotherapy is critical in patients with poor prognostic indicators after excluding HSVE relapse via polymerase chain reaction testing of cerebrospinal fluid.

Anahtar Kelimeler

• Herpes simplex virüs encephalitis
• autoimmune encephalitis
• lateralized periodic discharges
• anti-NMDAR encephalitis

Kaynakça

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