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Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association with Ovarian Teratoma.
Cureus. 2017 Jul 05; 9(7):e1425.C

Abstract

Anti-N-methyl-D-aspartate-Receptor (NMDAR) encephalitis is an autoimmune disorder with a multifaceted presentation that involves memory deficits, psychiatric symptoms, and autonomic instability. This case report describes the classic presentation of Anti-NMDAR encephalitis and highlights its association with ovarian teratomas. We present a 26 -year-old female who came in with new onset seizures and altered mentation who subsequently developed automatism. Electroencephalograms (EEG) showed left frontal spikes and right temporal delta activity. Magnetic resonance imaging (MRI) revealed right temporal hyper-intensity. The diagnosis was established with positive anti-NMDAR antibodies in the cerebrospinal fluid (CSF). The patient was initially treated with steroids and valproic acid, however, her condition progressively worsened. A five-day course of intravenous immunoglobulins (IVIG) was started followed by rituximab. The clinical course was complicated with the patient developing neutropenic fever and cerebrospinal fluid cultures (CSF) growing methicillin-sensitive Staphylococcus aureus (MSSA). She underwent pelvic imaging which showed a right ovarian teratoma. Evidence suggests that removal of ovarian tumor leads to better clinical and mortality outcomes in patients with Anti-NMDAR encephalitis. It is important for the internist to consider paraneoplastic syndromes in patients with Anti-NMDAR encephalitis.

Authors+Show Affiliations

Department of Neurology, Mount Sinai Hospital New York, Usa.Shifa International Hospital, Shifa International Hospital, Islamabad, Pakistan.Shifa Tameer E Millat University, Shifa International Hospital, Islamabad, Pakistan.Department of Medicine, Mahroof Hospital.Department of Medicine, Montefiore New Rochelle Hospital, Albert Einstein College of Medicine, Ny, Usa.Internal Medicine, University of Lahore, Lahore, Pakistan.Department of Medicine, Shifa International Hospital, Islamabad, Pakistan.

Pub Type(s)

Case Reports

Language

eng

PubMed ID

28884051

Citation

Ahmad, Javaad, et al. "Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association With Ovarian Teratoma." Cureus, vol. 9, no. 7, 2017, pp. e1425.
Ahmad J, Sohail MS, Khan A, et al. Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association with Ovarian Teratoma. Cureus. 2017;9(7):e1425.
Ahmad, J., Sohail, M. S., Khan, A., Qavi, A. H., Gaudel, P., Zahid, M., & Assad, S. (2017). Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association with Ovarian Teratoma. Cureus, 9(7), e1425. https://doi.org/10.7759/cureus.1425
Ahmad J, et al. Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association With Ovarian Teratoma. Cureus. 2017 Jul 5;9(7):e1425. PubMed PMID: 28884051.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Anti-n-Methyl-d-Aspartate-Receptor (NMDAR) Encephalitis in Association with Ovarian Teratoma. AU - Ahmad,Javaad, AU - Sohail,Muhammad Saad, AU - Khan,Amina, AU - Qavi,Ahmed H, AU - Gaudel,Pramod, AU - Zahid,Mehr, AU - Assad,Salman, Y1 - 2017/07/05/ PY - 2017/9/9/entrez PY - 2017/9/9/pubmed PY - 2017/9/9/medline KW - anti-nmda receptor encephalitis KW - anti-nmdar KW - nmda KW - nmdar encephalitis KW - ovarian teratoma SP - e1425 EP - e1425 JF - Cureus JO - Cureus VL - 9 IS - 7 N2 - Anti-N-methyl-D-aspartate-Receptor (NMDAR) encephalitis is an autoimmune disorder with a multifaceted presentation that involves memory deficits, psychiatric symptoms, and autonomic instability. This case report describes the classic presentation of Anti-NMDAR encephalitis and highlights its association with ovarian teratomas. We present a 26 -year-old female who came in with new onset seizures and altered mentation who subsequently developed automatism. Electroencephalograms (EEG) showed left frontal spikes and right temporal delta activity. Magnetic resonance imaging (MRI) revealed right temporal hyper-intensity. The diagnosis was established with positive anti-NMDAR antibodies in the cerebrospinal fluid (CSF). The patient was initially treated with steroids and valproic acid, however, her condition progressively worsened. A five-day course of intravenous immunoglobulins (IVIG) was started followed by rituximab. The clinical course was complicated with the patient developing neutropenic fever and cerebrospinal fluid cultures (CSF) growing methicillin-sensitive Staphylococcus aureus (MSSA). She underwent pelvic imaging which showed a right ovarian teratoma. Evidence suggests that removal of ovarian tumor leads to better clinical and mortality outcomes in patients with Anti-NMDAR encephalitis. It is important for the internist to consider paraneoplastic syndromes in patients with Anti-NMDAR encephalitis. SN - 2168-8184 UR - https://www.unboundmedicine.com/medline/citation/28884051/Anti_n_Methyl_d_Aspartate_Receptor__NMDAR__Encephalitis_in_Association_with_Ovarian_Teratoma_ L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28884051/ DB - PRIME DP - Unbound Medicine ER -
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