Ovarian Teratoma and N-Methyl-D-Aspartate Receptor Autoimmune Encephalitis: Insights Into Imaging Diagnosis of Teratoma and Timing of Surgery

Abstract

Mature ovarian teratoma is the most common type of germ cell tumor and mostly detected incidentally in women in second or third decade. Recent researches have provided strong evidence between mature ovarian teratoma and encephalitis, which is caused due to the presence of anti-N-methyl-D-aspartate (NMDA) antibodies. We would like to report four patients who had typical neuropsychiatric manifestations, such as abnormal behavior, speech disorder, seizures, movement disorders, loss of consciousness, and autonomic dysfunction. All the patients had prolonged course of disease before the diagnosis of NMDA encephalitis had been made. The importance of timely evaluation of symptomatic young women with serum and cerebrospinal fluid (CSF) NMDA receptor (NMDAR) antibodies is emphasized. Imaging ranging from transvaginal ultrasound to positron emission tomography-computed tomography (PET-CT) will help in arriving at a probable diagnosis. Surgical treatment is the cornerstone of management, and patients responded well post surgery with almost full recovery, with addition of immunotherapy, physiotherapy, rehabilitation providing a vital role. There is significant variation in clinical presentation of encephalitis and thus in time to diagnosis for those with non-specific symptoms, particularly psychiatric ones. The index of suspicion of anti-NMDA encephalitis should be high in young females and involvement of a gynecology team needs to be done. Surgical removal of the teratoma is the key and the gynecology team should not be deterred by the acute symptoms and debilitating nature of the symptoms

J Clin Gynecol Obstet. 2021;10(1):22-27
doi: https://doi.org/10.14740/jcgo715