Background and aims: Anti-N-methyl-D-aspartate
receptor encephalitis (Anti-NMDARE) is an increasingly
recognized, potentially lethal syndrome of psychiatric and
neurological dysfunction which includes seizures in young
patients, who have an underlying tumor. We present the
challenges involved in its diagnosis and management.
Methods: The case of a 28 year old female, hospitalized
after two focal seizures, with impaired awareness and
evolution to bilateral tonic-clonic, 1st life event, without
previous neurological, psychiatric pathology or seizures.
Prior to admission, she was discharged from the gynecology
department after a laparoscopic right ovarian cystectomy.
Results: At admission she was afebrile, without focal
neurological deficits or meningeal signs. Paraclinical and
imagistic without abnormalities, only focal left slowing on
electroencephalography and at histology – mature ovarian
teratoma. During the hospitalization she developed
psychiatric symptoms (confusion, self-aggression,
hallucinations), orofacial dyskinesias and involuntary
movements of the upper extremities which progressed to
catatonia, requiring specialized treatment in the psychiatric
hospital. Preventively we collected serum ´Anti-NMDAR
antibodies. Following a positive result, she was readmitted,
performed an EEG, excluded the delta brush pattern or nonconvulsive
seizures; brain and pelvic MRI was without
changes. Initiated specific treatment – plasmapheresis, with
improvement of the psychoneurological condition, and
antiepileptic drugs, followed by oral corticosteroids. Conclusion: Anti-NMDARE is a challenging condition,
requiring greater emphasis of clinical and paraclinical
manifestations, antibodies determination in order to prevent
misdiagnosis. This case illustrates the importance of
suspecting an autoimmune encephalitis even if the ovarian
teratoma was removed and symptoms do not follow a strict
phase progression and the results of antibody testing are
delayed.
Disclosure: Nothing to declare.