title: Reversible paraneoplastic encephalitis in three patients with ovarian neoplasms.
abstract: Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is a recently described potentially lethal but treatable disorder that often occurs as a paraneoplastic manifestation of ovarian teratomas. We report three women with this disorder who presented with subacute onset of delirium, seizures and autonomic instability. Anti-NMDA receptor antibodies were detectable in the serum or cerebrospinal fluid of each patient. Ovarian masses were detected in two patients, and subsequently excised. In the third patient, an empirical bilateral salpingo-oophorectomy was performed and revealed a microscopic neoplasm. All patients experienced slow reversal of the neurological symptoms following surgery and immunotherapy. Our experience suggests that prompt syndrome recognition followed by tumor removal and immunotherapy usually results in neurological recovery.
authors.affiliation: Division of Gynecologic Oncology, University of Pennsylvania Health System, Philadelphia, PA, USA.
authors.forename: Janos L
authors.initials: JL
authors.lastname: Tanyi
authors.forename: Evelyn B
authors.initials: EB
authors.lastname: Marsh
authors.forename: Josep
authors.initials: J
authors.lastname: Dalmau
authors.forename: Christina S
authors.initials: CS
authors.lastname: Chu
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000134:cerebrospinal fluid; D005260:Female; D006801:Humans; D007167:Immunotherapy; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000276:immunology / Q000473:pathology*; D010052:Ovariectomy; D020361:Paraneoplastic Syndromes, Nervous System / Q000276:immunology / Q000503:physiopathology* / Q000601:surgery; D016194:Receptors, N-Methyl-D-Aspartate / Q000276:immunology*; D012489:Salpingostomy; D013724:Teratoma / Q000276:immunology / Q000473:pathology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001323:Autoantibodies; D016194:Receptors, N-Methyl-D-Aspartate