Encefalita autoîmună - când susţinem diagnosticul în lipsa anticorpilor?

Autoimmu ne encephalitides a re disorders whose understanding knew a spectacular expansion in the last decade. Multiple parainfectious or paraneoplastic antibodies against a variety of cerebral intracellular or neuronal cell-surface epitopes have been described in this period of rime. The spectrum of these antibodies will be broadened in the future. We report the case of a 74-year-old man who, 3 weeks after a herpetic encephalitis, presented worsening of residual deficits (mixed aphasia and right hemiparesis), stupor and epileptic seizures, w ith recovery after corticotherapy escalation, A viral relapse was excluded. Subsequent tappering of corticoids was accompanied by a similar clinical picture at 3 and 4 months after initial presentation. According to literature, 20% of herpetic encephalitides relapsesare caused by an autoimmune process occuring in the first weeks after the initial infection, most o f them w ith anti-NMDA antibodies. The presence of these antibodies was also reported in 30% of CMS infections w ith the herpes simplex virus, regardless o f the subsequent development. In our case economic rationale limited the biological Investigation only to serum anti-NMDA andanti-VGKC antibodies - both negative, in such situations where logistical issues interfere with ideal medical practice or when there is a negative extensive autoimmune assessment, clinical and paradinical criteria were introduced to guide the practitioner in establishing the likelihood of an autoimmune encephalitis. [ABSTRACT FROM AUTHOR]