Ensefalit: Tanı ve Tedavi
Özet
Ensefalit, beyin dokusunun inflamasyonu ile karakterize ciddi bir nörolojik acil durumdur. Viral, bakteriyel, otoimmün ve özellikle immünsuprese kişilerde fungal hatta parazitik nedenlere bağlı gelişebilir. Klinik belirtiler; baş ağrısı, ateş, bilinç bulanıklığı, nöbetler ve fokal nörolojik defisitlerdir. Tanıda anamnez, nörolojik muayene, beyin omurilik sıvısı (BOS) analizi, Beyin görüntüleme ve Polimeraz Zincir Reaksiyonu (PCR) testi önemlidir. Herpes Simpleks Virüs (HSV) PCR testi duyarlılık ve özgüllük oranları %95'in üzerinde bildirilmiştir. Özellikle Amerika Bulaşıcı Hastalıklar Derneği kılavuzlarına göre, PCR testi yapılmadan HSV ensefalitinin dışlanmaması gerektiği belirtilir. Tedavi etiyolojiye göre değişir; HSV ensefalitinde acil olarak intravenöz asiklovir başlanmalıdır. HSV ensefaliti dışındaki ensefalitlerde tedavi, etiyolojiye göre değişkenlik gösterir. Otoimmün ensefalitte immünsupresif tedavi (kortikosteroidler, intravenöz İmmünoglobulin veya plazmaferez) tercih edilirken, bakteriyel ensefalitte geniş spektrumlu antibiyotikler hızlıca başlanmalıdır. Her vakada tedavi, altta yatan nedene göre değişmektedir. Komplikasyonların yönetimi, yoğun bakım desteği ve uzun süreli nörolojik takip gerektirir. Erken tanı ve tedavi prognoz belirleyicidir.
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