Abdul-Rahman Zainab M, Panegyres Peter K, Roeck Margareta, Hawkins David, Bharath Jude, Grolman Paul, Neppe Cliffe, Palmer David
Department of Medicine, Joondalup Health Campus, Joondalup, Western Australia, Australia.
Academy of Neurology, Joondalup Health Campus, Joondalup, Western Australia, Australia.
J Med Case Rep. 2016 Oct 24;10(1):296. doi: 10.1186/s13256-016-1067-4.
Anti-N-methyl-D-aspartate receptor encephalitis is a recently discovered disease entity of paraneoplastic limbic encephalitis. It largely affects young women and is often associated with an ovarian teratoma. It is a serious yet treatable condition if diagnosed early. Its remedy involves immunotherapy and surgical removal of the teratoma of the ovaries. This case of anti-N-methyl-D-aspartate receptor encephalitis involves an early surgical intervention with bilateral oophorectomy, despite negative imaging evidence of a teratoma.
A 25-year-old white woman with anti-N-methyl-D-aspartate receptor encephalitis presented with behavioral changes and seizures that were confirmed to be secondary to anti-N-methyl-D-aspartate receptor encephalitis. She required an admission to our intensive care unit for ventilator support and received a number of immunological therapies. Multiple imaging investigations showed no evidence of an ovarian teratoma; she had a bilateral oophorectomy 29 days after admission. Ovarian histology confirmed the presence of a teratoma with neuronal cells. A few days after the operation she began to show signs of improvement and, apart from mild short-term memory loss, she returned to normal function.
Our patient is an example of teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis, in which the teratoma was identified only microscopically. Her case highlights that even with negative imaging evidence of a teratoma, ovarian pathology should still be considered and explored.
抗N-甲基-D-天冬氨酸受体脑炎是一种最近发现的副肿瘤性边缘叶脑炎疾病实体。它主要影响年轻女性，常与卵巢畸胎瘤相关。如果早期诊断，这是一种严重但可治疗的疾病。其治疗方法包括免疫疗法和手术切除卵巢畸胎瘤。本病例的抗N-甲基-D-天冬氨酸受体脑炎患者尽管影像学检查未发现畸胎瘤证据，但仍接受了早期双侧卵巢切除术的手术干预。
一名患有抗N-甲基-D-天冬氨酸受体脑炎的25岁白人女性出现行为改变和癫痫发作，经证实是由抗N-甲基-D-天冬氨酸受体脑炎继发引起。她需要入住我们的重症监护病房接受呼吸机支持，并接受了多种免疫治疗。多次影像学检查未发现卵巢畸胎瘤的证据；她在入院29天后接受了双侧卵巢切除术。卵巢组织学检查证实存在含有神经细胞的畸胎瘤。手术后几天，她开始出现好转迹象，除了轻度短期记忆丧失外，她恢复了正常功能。
我们的患者是畸胎瘤相关抗N-甲基-D-天冬氨酸受体脑炎的一个例子，其中畸胎瘤仅在显微镜下被发现。她的病例突出表明，即使影像学检查未发现畸胎瘤证据，仍应考虑并探索卵巢病理情况。
