Anti-NMDAR encephalitis - rare complication after herpes virus encephalitis with a case report

Abstract

Herpes viral encephalitis are severely occurring diseases most commonly caused by HSV1 and HSV2 viruses. Characterized by severe leakage, significant lethality, especially in patients not treated with Aciclovir and persistent residual lesions. Although belonging to one group, the two viruses cause a different severity and localization clinic, with some age-specific features - HSV-1 is the most common among viral encephalitis. There is a characteristic temporal and temporopathic predisposition to brain damage and occurs predominantly at the age after 6 months of age. HSV-2 is found to be significantly less frequent with diffuse involvement of brain parenchyma, especially in newborns, as a result of infection due to female genital herpes infection. A combination of the two viruses is also possible, which determines even more significant injuries in the affected ones.
Anti-NMDAR encephalites belong to the group of autoimmune encephalitis - a group of heterogeneous diseases with underlying symptomsand diverse aetiology: idiopathic, post-infectious (viral, bactericidal), paraneoplastic and with a possible genetic predisposition. The greater incidence of this encephalitis in Herpes viral encephalitis with relevant extrapyramidal syndrome in infancy is known.
The purpose of this article is to provide a brief overview of the clinic, diagnosis and treatment of Herpes and anti-NMDAR encephalitis, as well as a verified case of Herpes encephalitis with established anti-NMDAR antibodies in CSF.