Herpes simpleks meningoensefaliti: Onbir olgunun değerlendirilmesi

Nurgül CERAN, Şenol ÇOMOĞLU, Öztürk Derya ENGİN, Paşa GÖKTAŞ, Emin KARAGÜL

Özet

Herpes simpleks mennigoensefaliti merkezi sinir siste-minin en yaygin ve en ciddi infeksiyonlarmdan biridir. Er-ken tani ve tedavi hastaligm prognozunu belirlemede 50k onemlidir. Bu cahsmadaii herpes simpleks menin-goensefalitli olgu sunulmu§ ve klinik 6'zellikleri, tani yon-temleri, tedavi ve prognozlan tartisilmi§tir. Olgularm ta-nisi klinik bulgular, beyin omurilik SIVISI (BOS) bulgulan, kraniyal magnetik rezonans (KMR) goruntuleme bulgulan ve elektroensefalografi (EEG) bulgulan ile konulmus-tur. Biling degisjkligi butun olgularda, konvulziyon iki olguda, fokal norolojik defisit alti olguda saptanmistir. BOS ince-lemesinde lokosit sayisi 50-200 hucre/mm3 arasinda saptanmistir. Dort olguda BOS'ta eritrosit gorulmustur. EEG incelemesi yedi olguda yapilabilmistir. EEG yapilan butun olgularda temporal lokalizasyonlu, degisik derece-lerde organizasyon bozuklugu saptanmi§tir. Olgularm tumunde kraniyal MR'da temporal lob tutulumu gqzlen-mi§tir. Tedavide butun olgulara asiklovir verilmi§tir. iki olgu hastanede yattigi sirada, .bir olgu taburcu olduktan sonra kaybedilmistir. U5 olgu orta derecede sekelli ola-rak, be§ olgu ise norolojik defisitsiz taburcu edilmistir. Qali§mamizda EEG ve kraniyal MR incelemelerinin hiz-h ve pratik tani yontemi oldugu dusunulmu§ ve sonucla-n klinikle uyumlu bulunmu§tur. Herpes meningoensefa-litli olgularda tanida gecikmenin, sonuc uzerinde olum-suz etkileri gozlenmis. olup hizli, pratik, spesifik tani yon-temlerine gereksinim oldugu dusiJnulmektedir.

Abstract

Herpes simplex meningoencephalitis are among the most common and the most severe infections of the central nervous system. Early diagnosis and early treatment is very important for prognosis in this disease. In this study 11 cases of HSV meningoencephalitis were presented and their clinical features, diagnostic methods, treatment and prognosis were discussed. They were diagnosed with clinical presentations, cerebrospinal fluid (CSF) findings, magnetic resonance imaging (MRI) scan and EEG finding. Altered level of consciousness was seen in all cases, convulsion in two cases, focal neurologic deficits in six cases. The CSF white blood cell count was found 50-200 cell/mm3 . The CSF red blood cell is seen in four cases. EEG was performed to seven of this cases and revealed characteristic temporal lobe involvement. Temporal lobe involvement was detected with the MRI scan in all cases. Acyclovir was given in the treatment of HSV meningoencephalitis cases. Two patient were died while at hospitali-zation, one patient was died after hospital discharge, three patients were discharged with mild sequelae and 5 cases were discharged without any neurological deficit. In our study it was conclude that EEG and MRI scan are quick and practical diagnostic methods and their results are identical to clinical findings. We observed that delay in diagnoses of HSV encephalitis has negative effects on outcome. We think that the finding of quick practical and specific new diagnostic methods are needed.