NEUROLOGICAL SEQUELAE OF ANTI-NMDAR ENCEPHALITIS IN THE PRESENCE OF AN IMMATURE OVARIAN TERATOMA: A CASE REPORT

Abstract

Anti-N-Methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a condition that presents with signs of altered mental status often quite spontaneously in patients. It can be traced to autoimmune conditions or certain tumors that produce antibodies against the anti-N-Methyl-D-aspartate receptors in the brain. NMDA receptors are expressed on pyramidal neurons all throughout the cerebral cortex as well as in the hippocampus thus influencing the creation of memories. Therefore, the presence of anti-NMDAR encephalitis can cause multiple neurological sequelae that subsequently presents with altered mental status that may progress to seizures and death. Females are more likely to be affected by this disease, especially those in the 25 to 35 year age group. In 2005, four women with age ranges 14-28 were found to have ovarian teratomas as well as memory loss combined with psychiatric changes that eventually was diagnosed as anti-NMDAR encephalitis. This link between teratomas and encephalitis shows a paraneoplastic pattern that has mostly been associated with mature ovarian teratomas in females, although it can happen in males as well. If caught in time, immediate surgical removal of the tumor as well as immunotherapy and steroid treatment can reverse much of the neurological impairment in patients. This is a case report of a patient with a rare immature teratoma and gliomatosis peritonei that will highlight the importance of pelvic imaging early on in the work-up for self-reported abnormal neurological deficits.