Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations

Liu, Haiyang; Jian, Minyu; Liang, Fa; Yue, Hongli; Han, Ruquan

doi:10.1186/s12871-015-0134-5

Cited by 16 publications

(9 citation statements)

References 33 publications

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“…A review of 349 PSH case reports found that about 80% of PSH followed TBI, 10% followed anoxic brain injury, 5% followed stroke, and the remaining 5% occurred in association with hydrocephalus, tumors, hypoglycemia, infections, or unspecified causes [7]. To date there were only few case reports available describing the association of anti-NMDAR encephalitis with PSH [8,9]. Of note, although the cases formally diagnosed PSH was rare in anti-NMDAR encephalitis, autonomic instability has been reported in anti-NMDAR encephalitis with a frequency of 69-89% in various case series [10,11].…”

Section: Discussionmentioning

confidence: 99%

Successful Management of Paroxysmal Sympathetic Hyperactivity in Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Cheng¹,

C²

2019

JCR

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Background: Paroxysmal sympathetic hyperactivity (PSH) is a hyper-adrenergic clinical syndrome that is predominantly described in acquired brain injuries, less commonly in other acquired brain injuries. The association of anti-N-Methyl-D-Aspartate Receptor (NMDAR) encephalitis and PSH is not well established. Case Report: We reported a PSH associated with anti-NMDAR encephalitis and the successful management of this case. A 32-year-old female presented with episodic involuntary movement and rapidly progressed to seizure and acute confusion. Further investigations confirmed the diagnosis of ovarian teratoma associated anti-NMDAR encephalitis which was treated with pulsed methyl-prednisolone, immunotherapy, and ovarian cystectomy. She developed episodic fever, tachycardia, hypertension, diaphoresis, and dystonia during her hospital stay. PSH was suspected after other causes were excluded and the diagnosis was made more probable by applying PSH assessment measure (PSH-AM). A combination of pharmacological agents was started with good response. At 9 months from symptoms onset, she achieved almost complete recovery and returned to work. Conclusion: This case report raises the awareness of PSH in anti-NMDAR encephalitis and illustrates the use of PSH-AM as an assessment tool to diagnose PSH and assess its severity. When PSH was recognized early and treated aggressively, good outcome can be achieved.

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Section: Discussionmentioning

confidence: 99%

Successful Management of Paroxysmal Sympathetic Hyperactivity in Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Cheng¹,

C²

2019

JCR

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“…NMDARs are heteromers of NMDAR1 and NMDAR2 subunits, which bind with glycine and glutamate, respectively (Tachibana et al, 2013). NMDAR hyperfunction is proposed to result in psychosis (Liu et al, 2015). Anti-NMDAR encephalitis represents a state of NMDAR hypofunction caused by autoantibodies against NMDAR (Warikoo et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases

Yang

Xia

et al. 2019

Front. Neurosci.

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The main clinical manifestations of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis are acute or subacute seizures, cognition impairment, and psychiatric symptoms. Nowadays, the scheme of antipsychotic therapy for this disease has not been established. This study reports three cases of anti-NMDAR encephalitis with psychiatric symptoms. The anti-NMDAR antibodies in cerebrospinal fluid (CSF) and serum were positive. The psychiatric symptoms still existed after intravenous immunoglobulin (IVIG) treatment; thus, clozapine was used for antipsychotic therapy. Case 1 was a 37-year-old man who suffered from bad mood and suicide behaviors for 1 month. Hallucination and delusion still existed after IVIG treatment and hormone therapy, and the symptoms were relieved when given clozapine for 12 months. Case 2 was a 28-year-old man who was admitted to our hospital due to injuring other people and destructive behaviors for 2 days. He showed irritability, bad temper, declined cognition, and severe delusion of persecution after IVIG treatment and hormone therapy, but the psychiatric symptoms disappeared when given clozapine for 3 months. Case 3 was a 23-year-old man who suffered from headache and babbing for 7 days. Symptoms such as irritability, bad temper, babbing, and injuring other people still existed after IVIG treatment and hormone therapy, but they disappeared when given clozapine for 2 months. Therefore, we suggest that during the treatment of anti-NMDAR encephalitis with psychiatric symptoms, if the anti-NMDAR antibodies in CSF and serum were positive, and psychiatric symptoms could not be controlled after IVIG and hormone therapy, clozapine may work.

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“…Total intravenous anaesthesia appears to be an alternative method for maintenance of anaesthesia in patients with SPS and anti-NMDAR encephalitis 26. Propofol, remifentanil and sufentanil infusions have been used to maintain anaesthesia in patients with anti-NMDAR encephalitis without significant adverse effects 27…”

Section: Discussionmentioning

confidence: 99%

Anaesthetic management of a patient with a unique combination of anti-N-methyl-D-aspartate receptor encephalitis and stiff-person syndrome

et al. 2018

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Stiff-person syndrome (SPS) and anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis are rare paraneoplastic syndromes caused by antibodies that target the central nervous system. Here, we describe a 26-year-old woman who presented with psychosis, amnesia, rigidity and fever. After extensive diagnostic and laboratory workup, she was diagnosed with an ovarian teratoma which was causing the symptoms of anti-NMDAR encephalitis and SPS. The patient was successfully treated with laparoscopic removal of the ovarian tumour under general anaesthesia. She was placed on immunosuppressant medications preoperatively and postoperatively, and her symptoms gradually resolved. Although there are case reports regarding the anaesthetic management of SPS and anti-NMDAR encephalitis, our study is the first report of a patient afflicted with both conditions.

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Anti-N-methyl-D-aspartate receptor encephalitis associated with an ovarian teratoma: two cases report and anesthesia considerations

Cited by 16 publications

References 33 publications

Successful Management of Paroxysmal Sympathetic Hyperactivity in Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Successful Management of Paroxysmal Sympathetic Hyperactivity in Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Effect of Clozapine on Anti-N-Methyl-D-Aspartate Receptor Encephalitis With Psychiatric Symptoms: A Series of Three Cases

Anaesthetic management of a patient with a unique combination of anti-N-methyl-D-aspartate receptor encephalitis and stiff-person syndrome

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