Taksim Eğitim ve Araştırma Hastanesi, Nöroloji Kliniği, İstanbul, Türkiye ÖZET Herpes simpleks ensefaliti, akut ensefalitlerin en yaygın formudur. Tedavisiz %70 oranında mortal seyreder. Beyin omurilik sıvısında herpes simpleks virüs pozitifliği ve manyetik rezonans görüntüleme erken tanıda önemlidir. Nadiren olgumuzdaki gibi BOS incelemesinde HSV pozitifliği saptanmadığında tanı klinik ve radyolojik görüntülerle konur. Kırk dört yaşında erkek hasta, ateş, baş ağrısı, bilinç bulanıklığı ve jeneralize nöbet nedeniyle incelendi. Bilinci somnolans, kooperasyonu kısıtlı, ense sertliği mevcuttu. Ateşi 38°C idi. Konuşma dizartrik, kelime bulmakta zorlanıyordu. BOS incelemesinde 1-2 lökosit, 15-20 eritrosit, hafif protein artışı mevcuttu. Difüzyon MRG'de sol temporal lob anteriorunda hiperintesite izlendi. Tekrarlanan MRG'de lezyonun frontal loba yayılmasına rağmen erken ve geç dönemde tekrarlanan serum ve BOS HSV Tip1-2 IgM-IgG, HSV Tip1-2 polimeraz zincir reaksiyonu negatifti. Klinik öykü ve radyolojik görüntülerle olası herpes ensefaliti düşünülen hastamız antiviral tedavi ile sekelsiz iyileşti. Günümüzde herpes ensefaliti tanısında PCR yöntemi altın standart olarak kabul edilmektedir. Nadiren olgumuzdaki gibi PCR negatifliğinde klinik ve radyolojik görüntüleme ile herpes ensefalitinden şüphelenildiğinde tedaviye erken başlamak hayat kurtarıcıdır. (JAREM 2012; 2: 29-32) Anahtar Sözcükler: Ensefalit, herpes simpleks virüs, polimeraz zincir reaksiyonu, beyin omurilik sıvısı, görüntüleme, prognoz ABSTRACT Herpes simplex encephalitis is the most common form of acute encephalitis. Untreated Cases have a mortality of 70%. In early diagnosis, herpes simplex virus positivity in cerebrospinal fluid and magnetic resonance imaging is important. Rarely, as seen in our case, HSV positivity is not detected in CSF analysis diagnosed with clinical and radiological images. A male patient, who was 44 years old, was examined because of fever, headache, confusion and generalized seizures. He had somnolence, limited cooperation, neck stiffness, and fever of 38°C. There was dysarthria in speech and he had difficulty finding words. Examination of CSF leukocyte revealed 1-2, 15-20 red blood cells and a slight increase in protein. In diffusion MRI, hyperintensity was observed in the anterior left temporal lobe. Despite a lesion which spread to the frontal lobe on repeated MRI, repeated early and late period serum and CSF tests for HSV type 1-2 IgM-IgG and HSV type 1-2, the PCR result was negative. Clinical history and radiological images suggest probable herpes encephalitis from which the patient recovered without sequelae with antiviral therapy. Today, the PCR method is considered the gold standard in the diagnosis of herpes encephalitis. However, when the disease is suspected following clinical tests and radiological images,, even if there is PCR negativity, early treatment can be life saving. (JAREM 2012; 2: 29-32)

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Paget's disease of the bone is a chronic, focal skeletal disease characterized by bone pain and deformity, pathological fractures and neurological symptoms such as headache, hearing loss and tinnitus, etc. The frequency of the disease increases in later ages. Viral and genetical factors play a role in the etiology. The majority of cases are asymptomatic. It is often diagnosed with an incidental finding on radiography or with an unexpected high serum alkaline phosphatase level. Bone fractures or neurological complications can negatively affect the quality of life. Early diagnosis and treatment are thus very important. Bisphosphonates are the most frequently used medication in the treatment. We present a case who sought medical help because of headache and was diagnosed as Paget's disease. Neurological complications and the diagnosis and treatment of Paget's disease are reviewed in the literature.

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