Skip to main content
Top
Published in: World Journal of Surgical Oncology 1/2014

Open Access 01-12-2014 | Case report

Anti-NMDAR limbic encephalitis- a clinical curiosity

Authors: Abhay K Kattepur, Darshan Patil, Amarendra Shankarappa, Shivananda Swamy, Nayakanur Shankarappa Chandrashekar, Pushpa Chandrashekar, Shailesh Prabhu, Kodaganur Srinivas Gopinath

Published in: World Journal of Surgical Oncology | Issue 1/2014

Login to get access

Abstract

Background

Neurological paraneoplastic syndromes are rarely the first manifestation of an underlying cancer. A high index of suspicion is thus needed to diagnose such conditions. Paraneoplastic limbic encephalitis is one such entity which is well described in association with small cell lung cancers, testicular germ cell tumors, breast cancers and ovarian tumors. This article describes the entity being associated with an ovarian tumor.

Case

A 36-year-old female presented with abnormal behaviour, mood swings and delusions. She was evaluated for her psychiatric symptoms and found to have an underlying ovarian tumor. Anti-NMDA receptor titers were strongly positive. She underwent oophorectomy, and post-operatively there was a significant improvement in her psychiatric symptoms.

Conclusions

Ovarian tumors like teratomas are implicated in the pathogenesis of paraneoplastic limbic encephalitis. An underlying ovarian tumor must be evaluated in all young females presenting with sudden onset of psychiatric symptoms.
Appendix
Available only for authorised users
Literature
1.
go back to reference Takahashi Y, Mogami Y, Takayama R, Ikeda H, Imai K: Antibodies to glutamate receptor in limbic encephalitis. Brain Nerve. 2010, 62 (8): 827-837.PubMed Takahashi Y, Mogami Y, Takayama R, Ikeda H, Imai K: Antibodies to glutamate receptor in limbic encephalitis. Brain Nerve. 2010, 62 (8): 827-837.PubMed
2.
go back to reference Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J: Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 2005, 58 (4): 594-604. 10.1002/ana.20614.PubMedCentralCrossRefPubMed Vitaliani R, Mason W, Ances B, Zwerdling T, Jiang Z, Dalmau J: Paraneoplastic encephalitis, psychiatric symptoms, and hypoventilation in ovarian teratoma. Ann Neurol. 2005, 58 (4): 594-604. 10.1002/ana.20614.PubMedCentralCrossRefPubMed
3.
go back to reference Schmiedeskamp M, Cariga P, Ranta A: Anti-NMDA-receptor autoimmune encephalitis without neoplasm: a rare condition. NZMJ. 2010, 123 (1322): 67-68. Schmiedeskamp M, Cariga P, Ranta A: Anti-NMDA-receptor autoimmune encephalitis without neoplasm: a rare condition. NZMJ. 2010, 123 (1322): 67-68.
4.
go back to reference Dalmau J, Tuzun E, Wu H, Masjuan J, Rossi J, Voloschin A: Paraneoplastic anti-n-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007, 61: 25-36. 10.1002/ana.21050.PubMedCentralCrossRefPubMed Dalmau J, Tuzun E, Wu H, Masjuan J, Rossi J, Voloschin A: Paraneoplastic anti-n-methyl-d-aspartate receptor encephalitis associated with ovarian teratoma. Ann Neurol. 2007, 61: 25-36. 10.1002/ana.21050.PubMedCentralCrossRefPubMed
5.
go back to reference Joyce WTL, Eric YCL, Betty LH, Fu MH, Yip KK, Chan RTM, Chang CM: Anti-N-methyl-D-aspartate receptor encephalitis in a young woman with an ovarian tumour. Hong Kong Med J. 2010, 16: 313-316. Joyce WTL, Eric YCL, Betty LH, Fu MH, Yip KK, Chan RTM, Chang CM: Anti-N-methyl-D-aspartate receptor encephalitis in a young woman with an ovarian tumour. Hong Kong Med J. 2010, 16: 313-316.
6.
go back to reference Kawano H, Hamaguchi E, Kawahito S, Tsutsumi YM, Tanaka K, Kitahata H, Oshita S: Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies. Anaesthesia. 2011, 66: 515-518. 10.1111/j.1365-2044.2011.06707.x.CrossRefPubMed Kawano H, Hamaguchi E, Kawahito S, Tsutsumi YM, Tanaka K, Kitahata H, Oshita S: Anaesthesia for a patient with paraneoplastic limbic encephalitis with ovarian teratoma: relationship to anti-N-methyl-D-aspartate receptor antibodies. Anaesthesia. 2011, 66: 515-518. 10.1111/j.1365-2044.2011.06707.x.CrossRefPubMed
7.
go back to reference Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D: Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012, 79 (11): 1094-1100. 10.1212/WNL.0b013e3182698cd8.PubMedCentralCrossRefPubMed Schmitt SE, Pargeon K, Frechette ES, Hirsch LJ, Dalmau J, Friedman D: Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis. Neurology. 2012, 79 (11): 1094-1100. 10.1212/WNL.0b013e3182698cd8.PubMedCentralCrossRefPubMed
8.
go back to reference Gultekin SH, Rosenfeld M, Voltz R, Eichen J, Posner JB, Dalmau J: Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000, 123: 1481-1494. 10.1093/brain/123.7.1481.CrossRefPubMed Gultekin SH, Rosenfeld M, Voltz R, Eichen J, Posner JB, Dalmau J: Paraneoplastic limbic encephalitis: neurological symptoms, immunological findings and tumour association in 50 patients. Brain. 2000, 123: 1481-1494. 10.1093/brain/123.7.1481.CrossRefPubMed
9.
go back to reference Vedeler CA, Storstein A: Autoimmune limbic encephalitis. Actaneurologica Scandinavica. 2009, 189: 63-67.CrossRef Vedeler CA, Storstein A: Autoimmune limbic encephalitis. Actaneurologica Scandinavica. 2009, 189: 63-67.CrossRef
10.
go back to reference Ferdinand P, Mitchell L: Anti-NMDA receptor encephalitis. J Clin Cell Immunol. 2012, S10: 007-doi:10.4172/2155-9899.S10-007 Ferdinand P, Mitchell L: Anti-NMDA receptor encephalitis. J Clin Cell Immunol. 2012, S10: 007-doi:10.4172/2155-9899.S10-007
11.
go back to reference Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R: Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011, 10 (1): 63-74. 10.1016/S1474-4422(10)70253-2.PubMedCentralCrossRefPubMed Dalmau J, Lancaster E, Martinez-Hernandez E, Rosenfeld MR, Balice-Gordon R: Clinical experience and laboratory investigations in patients with anti-NMDAR encephalitis. Lancet Neurol. 2011, 10 (1): 63-74. 10.1016/S1474-4422(10)70253-2.PubMedCentralCrossRefPubMed
Metadata
Title
Anti-NMDAR limbic encephalitis- a clinical curiosity
Authors
Abhay K Kattepur
Darshan Patil
Amarendra Shankarappa
Shivananda Swamy
Nayakanur Shankarappa Chandrashekar
Pushpa Chandrashekar
Shailesh Prabhu
Kodaganur Srinivas Gopinath
Publication date
01-12-2014
Publisher
BioMed Central
Published in
World Journal of Surgical Oncology / Issue 1/2014
Electronic ISSN: 1477-7819
DOI
https://doi.org/10.1186/1477-7819-12-256

Other articles of this Issue 1/2014

World Journal of Surgical Oncology 1/2014 Go to the issue