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Neurological response to early removal of ovarian teratoma in anti-NMDAR encephalitis
  1. M Seki (seki-med{at}sc.itc.keio.ac.jp)
  1. Department of Neurology, School of Medicine, Keio University, Japan
    1. S Suzuki (shigeaki{at}sc.itc.keio.ac.jp)
    1. School of Medicine, Keio University, Japan
      1. T Iizuka (takahiro{at}med.kitasato-u.ac.jp)
      1. Department of Neurology, School of Medicine, Kitasato University, Japan
        1. T Shimizu (shimizu-toshi{at}umin.ac.jp)
        1. Department of Neurology, School of Medicine, Keio University, Japan
          1. Y Nihei (sp5b4h89{at}leaf.ocn.ne.jp)
          1. Department of Neurology, School of Medicine, Keio University, Japan
            1. N Suzuki (nrsuzuki{at}sc.itc.keio.ac.jp)
            1. Department of Neurology, School of Medicine, Keio University, Japan
              1. J Dalmau (josep.dalmau{at}uphs.upenn.edu)
              1. Department of Neurology, Division of Neuro-oncology, University of Pennsylvania, United States

                Abstract

                We report an 18-year-old woman with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, who developed psychiatric symptoms, progressive unresponsiveness, dyskinesias, hypoventilation, hypersalivation and seizures. Early removal of an ovarian teratoma followed by plasma exchange and corticosteroids resulted in a prompt neurological response and eventual full recovery. Serial analysis of antibodies to NR1/NR2B heteromers of the NMDAR showed an early decrease of serum titers, although the CSF titers correlated better with clinical outcome. Patientfs antibodies reacted with areas of the tumor that contained NMDAR-expressing tissue. Search for and removal of a teratoma should be promptly considered after the diagnosis of anti-NMDAR encephalitis.

                • NMDA receptor
                • early treatment
                • encephalitis
                • ovarian teratoma
                • paraneoplastic

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