Anti NMDA Reseptor Encephalitis
Asu ÖZGÜLTEKİN, Mahsun KARA
Haydarpaşa Numune Eğitim ve Araştırma Hastanesi
Giriş: Patients with anti-NMDA receptor encephalitis may present with cognitive deficits, Early detection of Anti-NMDA receptor antibodies in CSF and serum can give a chance to early interventions.
Olgu: 20 years old woman suffered from headache, sleep disturbance and amnesia for the last 10 days.Antipsychotic treatment was prescribed from an outpatient clinic a week ago.She was admitted to the hospital with high fever, blurred consciousness and generalised tonic-clonic convulsions.Assessment of cerebro-spinal fluid(CSF) revealed no infectious cause.(GCS=9) was worsened and she transferred to the ICU where she was intubated for respiratory failure.There were no pathological findings on radiological investigations(MRI and CT).A second sample of CSF was sent for microbiological and antibody assesments.Acyclovire and IVIC(2gr/kg for 5 days) was started.Covid-19 PCR was negative. the patient was a young women with no obvious cause in CSF or radiological examinations, otoimmune encephalitis was suspected and pulse steroid(Metilprednisolon 1gr/day for 5 days) was added to the treatment.On the 10th day of her stay, she was diagnosed with anti-NMDA receptor encephalitis based on the presence of antibodies in the serum and CSF.On ultrasonıc examination of the abdomen, was found to have an ovarian teratoma and underwent oophorectomy. In the second week of intubation, tazocine was added for the ventilatory associated pneumonia.• Her neurological status was slightly recovered to GCS of 10-12 , but she was not able to wean from the ventilator leading to tracheostomy on the 19th day. Died of septic shock on the 25th day
Tartışma ve Sonuç: Anti-NMDA receptor encephalitis may present with cognitive deficits, Early detection of these receptor antibodies in CSF and serum, and ovarian teratomas in young woman can give a chance to early interventions. Patients can regain their cognitive functions and independency in months, but the pulse steroid treatment may prone the patients to nosocomial infections in ICU, causing dissappointing results like septic shock.
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