Ovarian Teratoma and N-Methyl-D-Aspartate Receptor Autoimmune Encephalitis: Insights Into Imaging Diagnosis of Teratoma and Timing of Surgery

Monica Thiyagarajan, Ajit Sebastian, Dhanya Susan Thomas, Anitha Thomas, Abraham Peedicayil, Vivek Mathew

Abstract


Mature ovarian teratoma is the most common type of germ cell tumor and mostly detected incidentally in women in second or third decade. Recent researches have provided strong evidence between mature ovarian teratoma and encephalitis, which is caused due to the presence of anti-N-methyl-D-aspartate (NMDA) antibodies. We would like to report four patients who had typical neuropsychiatric manifestations, such as abnormal behavior, speech disorder, seizures, movement disorders, loss of consciousness, and autonomic dysfunction. All the patients had prolonged course of disease before the diagnosis of NMDA encephalitis had been made. The importance of timely evaluation of symptomatic young women with serum and cerebrospinal fluid (CSF) NMDA receptor (NMDAR) antibodies is emphasized. Imaging ranging from transvaginal ultrasound to positron emission tomography-computed tomography (PET-CT) will help in arriving at a probable diagnosis. Surgical treatment is the cornerstone of management, and patients responded well post surgery with almost full recovery, with addition of immunotherapy, physiotherapy, rehabilitation providing a vital role. There is significant variation in clinical presentation of encephalitis and thus in time to diagnosis for those with non-specific symptoms, particularly psychiatric ones. The index of suspicion of anti-NMDA encephalitis should be high in young females and involvement of a gynecology team needs to be done. Surgical removal of the teratoma is the key and the gynecology team should not be deterred by the acute symptoms and debilitating nature of the symptoms




J Clin Gynecol Obstet. 2021;10(1):22-27
doi: https://doi.org/10.14740/jcgo715

Keywords


Mature ovarian teratoma; NMDA; Autoimmune encephalitis; Ovarian teratoma symptoms

Full Text: HTML PDF
 

Browse  Journals  

     

Journal of Clinical Medicine Research

Journal of Endocrinology and Metabolism

Journal of Clinical Gynecology and Obstetrics

World Journal of Oncology

Gastroenterology Research

Journal of Hematology

Journal of Medical Cases

Journal of Current Surgery

Clinical Infection and Immunity

Cardiology Research

World Journal of Nephrology and Urology

Cellular and Molecular Medicine Research

Journal of Neurology Research

International Journal of Clinical Pediatrics

 

 

 

 

 

Journal of Clinical Gynecology and Obstetrics, quarterly, ISSN 1927-1271 (print), 1927-128X (online), published by Elmer Press Inc.                     
The content of this site is intended for health care professionals.
This is an open-access journal, the authors retain the copyright, the journal is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International
License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Creative Commons Attribution license (Attribution-NonCommercial 4.0 International CC-BY-NC 4.0)


This journal follows the International Committee of Medical Journal Editors (ICMJE) recommendations for manuscripts submitted to biomedical journals,
the Committee on Publication Ethics (COPE) guidelines, and the Principles of Transparency and Best Practice in Scholarly Publishing.

website: www.jcgo.org   editorial contact: editor@jcgo.org
Address: 9225 Leslie Street, Suite 201, Richmond Hill, Ontario, L4B 3H6, Canada

© Elmer Press Inc. All Rights Reserved.