Anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma: A case report

Anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma: A case report Massa E, Mouloudi E, Kydona Ch, Papadopoulos S, Sgourou K, Gritsi-Gerogianni N We report a rare case of a young woman with anti-N-Methyl-D-Aspartate receptor (NMDAR) encephalitis, who developed psychiatric symptoms, dyskinesias, hypoventilation, hypersalivation and seizures. Serial analysis of antibodies to NR1/NR2B heteromers of the NMDAR was positive on the patient's serum and cerebrospinal fluid (CSF). Removal of an ovarian teratoma after intravenous immunoglobulin and corticosteroid therapy resulted in a prompt neurological response. INTRODUCTION Since its discovery in 2007, the encephalitis associated with antibodies against N-Methyl-DAspartate Receptor (NMDAR) has entered the mainstream of neurology and other disciplines. Paraneoplastic limbic encephalitis (PLE) is a rare neurological syndrome characterized by short-term memory impairment, seizures, involuntary movements and various psychiatric disturbances. It is often associated with breast cancer, germ-cell testicular tumors and small cell lung cancer, but rarely with ovarian teratomas. PLE associated with ovarian teratoma has recently been related to the development of antibodies to the NR1/NR2B heteromers of the NMethyl-D-Aspartate Receptor (NMDAR), the disorder being named anti-NMDAR encephalitis. Despite the severity of symptoms, most patients recover if the disorder is recognized and treated in time. Immumotherapy is often effective and The Greek E-Journal of Perioperative Medicine 2016; 15(b): 39-45 (ISSN 1109-6888) www. e-journal.gr/ Ελληνικό Περιοδικό Περιεγχειρητικής Ιατρικής 2016; 15(b): 39-45 (ISSN 1109-6888)www.e-journal.gr/ 40 ©2016 Society of Anesthesiology and Intensive Medicine of Northern Greece ©2016 ΕταιρείαΑναισθησιολογίαςκαιΕντατικήςΙατρικήςΒορείουΕλλάδος it has been suggested that prompt resection of the teratoma expedites recovery. In most previously reported cases of NMDAR encephalitis, the ovarian teratoma was removed a few months (median: 9 weeks) after the presentation of neurological symptoms, sometimes when symptoms had already partially responded to immunotherapy. We report the outcome in a young woman whose ovarian teratoma was removed one month after the onset of neurological symptoms.