Limbic encephalitis presenting with seizures, anterograde amnesia, and psychosis in a patient seven weeks status post immature ovarian teratoma removal.
A paraneoplastic syndrome associated with anti-N-methyl-D-asparate (NMDA) receptors can initially present as a neurologic or psychiatric disturbance. Removal of the tumor is usually curative, and the syndrome is associated with the presence, rather than the history, of tumor. We present a case in which a 25-year-old, Hispanic woman presented with seizures, memory loss, and unusual behavioral changes. The woman had a teratoma removed 2 months earlier. Because of the time course, a paraneoplastic syndrome was initially considered unlikely. Brain imaging, electroencephalography (EEG) and neurologic work-up were negative. The patient was treated for a suspected somatoform disorder and psychosis. Based on the clinical picture, the working diagnosis was changed to delirium due to paraneoplastic limbic encephalitis. A course of intravenous immunoglobins (IVIg), and high dose steroids was administered. The patient's symptoms improved, and she was discharged home. After discharge, studies came back positive for antibodies against NR1/NR2 of the NMDA receptor.
Kleyensteuber
Brian
B
Department of Mental Health, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA.
Ruterbusch
Victor
V
Bennett
Jason
J
Llewellyn
David
D
Loeffler
George
G
D000328:Adult; D020324:Amnesia, Anterograde / Q000175:diagnosis* / Q000188:drug therapy; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D004569:Electroencephalography; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D020363:Limbic Encephalitis / Q000175:diagnosis* / Q000188:drug therapy; D010051:Ovarian Neoplasms / Q000601:surgery; D010257:Paraneoplastic Syndromes / Q000175:diagnosis* / Q000188:drug therapy; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000188:drug therapy; D012640:Seizures / Q000175:diagnosis* / Q000188:drug therapy; D013256:Steroids / Q000627:therapeutic use; D013724:Teratoma / Q000601:surgery
D016756:Immunoglobulins, Intravenous; D013256:Steroids