Anti NMDAR ensefalitinde nöropsikiyatrik semptomların yönetimi: olgu sunumu
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Tarih
2024
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Cukurova University
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Anti-N-Metil-D-Aspartat reseptör (NMDAR) ensefaliti, en sık teşhis edilen otoimmün ensefalit olarak kabul edilmektedir ve ensefalitin en yaygın nedenlerinden biridir. Psikoz, katatoni, davranış ve hafıza değişiklikleri, nöbetler, anormal hareketler ve otonomik disregülasyon gibi geniş bir semptom yelpazesi genellikle multidisipliner bir tedavi yaklaşımı gerektirir. Erken tanı ve immünoterapinin hızlı bir şekilde başlatılması hasta sonuçlarını iyileştirir. 16 yaşında nöbet geçiren ve daha sonra katatoni ve psikotik semptomları olan bir kız olguyu sunuyoruz. Hastamız ilk basamak tedavilerden yeterince fayda görmeyince Rituxumab ile tedavi edildi. Rituxumab tedavisi sonrasında hem nörolojik hem de psikiyatrik semptomlarda belirgin düzelme meydana gelmiştir. Bu vaka, NMDAR ensefaliti olan hastalarda multidisipliner yaklaşımın önemini ve birinci basamak tedavilere yeterli yanıt vermeyen hastalarda ikinci basamak tedavilere erken geçişin önemini vurgulamaktadır. Erken tanı ve tedavinin nöropsikiyatrik semptomları dramatik bir şekilde iyileştirebileceğine ve bu nedenle klinisyenlerin ayırıcı tanıda NMDAR ensefalitini mutlaka hatırlamaları gerektiğine dikkat çekmek amaçlanmıştır.
Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is recognized as the most commonly diagnosed autoimmune encephalitis and is one of the most common causes of encephalitis. A wide spectrum of symptoms such as psychosis, catatonia, behavioral and memory changes, seizures, abnormal movements and autonomic dysregulation usually requires a multidisciplinary treatment approach.Early recognition and prompt initiation of immunotherapy improves patient outcomes.We present a case of a 16-year-old female who had seizures and later had catatonia and psychotic symptoms.Our patient was treated with Rituxumab when he did not get enough benefit from the first-line treatments. Significant improvement in both neurological and psychiatric symptoms occurred after rituxumab treatment.This case highlights the importance of multidisciplinary approach in patients with NMDAR encephalitis and the importance of early transition to second-line treatments in patients who do not respond adequately to first-line treatments. It is aimed to draw attention to the fact that early diagnosis and treatment can dramatically improve neuropsychiatric symptoms, and therefore clinicians should definitely remember NMDAR encephalitis in the differential diagnosis.
Anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis is recognized as the most commonly diagnosed autoimmune encephalitis and is one of the most common causes of encephalitis. A wide spectrum of symptoms such as psychosis, catatonia, behavioral and memory changes, seizures, abnormal movements and autonomic dysregulation usually requires a multidisciplinary treatment approach.Early recognition and prompt initiation of immunotherapy improves patient outcomes.We present a case of a 16-year-old female who had seizures and later had catatonia and psychotic symptoms.Our patient was treated with Rituxumab when he did not get enough benefit from the first-line treatments. Significant improvement in both neurological and psychiatric symptoms occurred after rituxumab treatment.This case highlights the importance of multidisciplinary approach in patients with NMDAR encephalitis and the importance of early transition to second-line treatments in patients who do not respond adequately to first-line treatments. It is aimed to draw attention to the fact that early diagnosis and treatment can dramatically improve neuropsychiatric symptoms, and therefore clinicians should definitely remember NMDAR encephalitis in the differential diagnosis.
Açıklama
Anahtar Kelimeler
Otoimmun Ensefalit, Psikoz, NMDAR, Autoimmune Encephalitis, Psychosis, NMDAR
Kaynak
Cukurova Medical Journal
WoS Q Değeri
Scopus Q Değeri
Cilt
49
Sayı
3
