Taiwanese Journal of Obstetrics & Gynecology (May 2019)

Anti-NMDAR encephalitis with ovarian teratomas: Review of the literature and two case reports

  • Hsiao-Chen Chiu,
  • Yu-Ching Su,
  • Su-Cheng Huang,
  • Han-Lin Chiang,
  • Pei-Shen Huang

Journal volume & issue
Vol. 58, no. 3
pp. 313 – 317

Abstract

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Objective: Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is a paraneoplastic syndrome associated with ovarian teratomas. Anti-NMDAR encephalitis patients typically present with prominent psychiatric symptoms, seizures, and involuntary movements; further, they rapidly progress to unresponsiveness with central hypoventilation and dysautonomia. Case report: This paper presents two anti-NMDAR encephalitis cases with ovarian teratomas and reviews 13 anti-NMDAR encephalitis clinical case reports in Taiwan, of which six involved ovarian tumors, five being mature teratomas. Patients presented with acute onset of psychiatric symptoms and subsequently developed coma within a few days. Anti-NMDAR encephalitis usually occurs in young women and is often associated with ovarian tumors, specifically teratomas. Ovarian cystectomy or oophorectomy was performed, which markedly improved cognitive function. Conclusion: Paraneoplastic neurological conditions associated with ovarian teratomas represent a fascinating disease process. Identifying the gynecological cause of a neurological condition, particularly in young women, followed by prompt treatment can remarkably improve clinical conditions and, thus, be lifesaving. Keywords: Anti-N-Methyl-d-aspartate receptor (anti-NMDAR) encephalitis, Autoimmune encephalitis, Ovarian teratoma, Paraneoplastic syndrome, Psychosis