N-Methyl-D-Aspartate Receptor Encephalitis with Psychiatric Symptoms and an Ovarian Teratoma Detected by MRI in a 17-Year-Old Girl

Abstract

N-methyl-D-aspartate receptor (NMDAR) encephalitis is a rare antibody-mediated autoimmune encephalitis often associated with an ovarian teratoma in adolescent females. Here we present a 17-year-old girl with only and unusual psychiatric symptoms as part of her NMDAR encephalitis in combination with a very small ovarian teratoma suspected by magnetic resonance (MR) imaging and finally histologically confirmed. We further review the literature of NMDAR encephalitis in combination with an ovarian teratoma and discuss the recommended radiological workup in children with a suspected ovarian tumor.

Keywords

NMDA receptor encephalitis - ovarian teratoma - MRI - psychiatric symptoms - laparoscopy - child

• References

• 1 Armangue T, Titulaer MJ, Málaga I. , et al; Spanish Anti-N-methyl-D-Aspartate Receptor (NMDAR) Encephalitis Work Group. Pediatric anti-N-methyl-D-aspartate receptor encephalitis-clinical analysis and novel findings in a series of 20 patients. J Pediatr 2013; 162 (02) 850.e2-856.e2
• 2 Dalmau J, Geis C, Graus F. Autoantibodies to synaptic receptors and neuronal cell surface proteins in autoimmune diseases of the central nervous system. Physiol Rev 2017; 97 (02) 839-887
• 3 Dalmau J, Gleichman AJ, Hughes EG. , et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies. Lancet Neurol 2008; 7 (12) 1091-1098
• 4 Mann AP, Grebenciucova E, Lukas RV. Anti-N-methyl-D-aspartate-receptor encephalitis: diagnosis, optimal management, and challenges. Ther Clin Risk Manag 2014; 10: 517-525
• 5 Titulaer MJ, McCracken L, Gabilondo I. , et al. Treatment and prognostic factors for long-term outcome in patients with anti-NMDA receptor encephalitis: an observational cohort study. Lancet Neurol 2013; 12 (02) 157-165
• 6 Haberlandt E, Ensslen M, Gruber-Sedlmayr U. , et al. Epileptic phenotypes, electroclinical features and clinical characteristics in 17 children with anti-NMDAR encephalitis. Eur J Paediatr Neurol 2017; 21 (03) 457-464
• 7 Gresa-Arribas N, Titulaer MJ, Torrents A. , et al. Diagnosis and significance of antibody titers in anti-NMDA receptor encephalitis, a retrospective study. Lancet Neurol 2014; 13 (02) 167-177
• 8 Scheer S, John RM. Anti-N-methyl-D-aspartate receptor encephalitis in children and adolescents. J Pediatr Health Care 2016; 30 (04) 347-358
• 9 Gomes Ferreira M, Lapresa Alcalde V, García Sánchez MH, Hernández Hernández L, Doyague Sánchez MJ. Successful treatment of anti-NMDA receptor encephalitis with early teratoma removal and plasmapheresis: A case report. Medicine (Baltimore) 2018; 97 (31) e11325
• 10 Chapman MR, Vause HE. Anti-NMDA receptor encephalitis: diagnosis, psychiatric presentation, and treatment. Am J Psychiatry 2011; 168 (03) 245-251
• 11 de Bruijn MAAM, Aarsen FK, van Oosterhout MP. , et al; CHANCE Study Group. Long-term neuropsychological outcome following pediatric anti-NMDAR encephalitis. Neurology 2018; 90 (22) e1997-e2005
• 12 Al-Diwani A, Handel A, Townsend L. , et al. The psychopathology of NMDAR-antibody encephalitis in adults: a systematic review and phenotypic analysis of individual patient data. Lancet Psychiatry 2019; 6 (03) 235-246
• 13 Warren N, Siskind D, O'Gorman C. Refining the psychiatric syndrome of anti-N-methyl-D-aspartate receptor encephalitis. Acta Psychiatr Scand 2018; 138 (05) 401-408
• 14 Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics 2001; 21 (02) 475-490
• 15 Crimì F, Camporese G, Lacognata C, Fanelli G, Cecchin D, Zoccarato M. Ovarian teratoma or uterine malformation? PET/MRI as a novel useful tool in NMDAR encephalitis. In Vivo 2018; 32 (05) 1231-1233