Anti-NMDAR encephalitis in a 19 year old female patient with ovarian teratoma: A case report

Hanna, Johnny El; Quenum, C; Arsalane, Abdelilah

doi:10.1016/j.eurox.2021.100129

Cited by 2 publications

(2 citation statements)

References 10 publications

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“…Besides surgery, an intervention with immunotherapy as second-line treatment may be effective in some clinical contexts. [ 1 15 16 ] Occasionally, immunotherapy was administered as the first line, but no recovery was demonstrated. [ 17 18 ] Importantly, the prognosis depends on the timing of appropriate intervention, resources of health-care settings, and the medical status of the patient.…”

Section: Discussionmentioning

confidence: 99%

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

Pham

Nguyen

2023

Gynecology and Minimally Invasive Therapy

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A previously fit and healthy 39-year-old woman was admitted to our tertiary referral hospital with coexisting autoimmune encephalopathy and ovarian tumor. Due to the presence of anti-N-methyl-d-aspartate receptor (anti-NMDAR) in the cerebrospinal fluid, a diagnosis of anti-NMDAR encephalitis was first suggested after ruling out other etiologies. Thus, a laparoscopy was promptly performed to remove the ovarian tumor. The histological endpoint revealed an ovarian teratoma. Consequently, the patient recovered completely in good health condition after 2 months in a coma status. Herein, we report an uncommon case of anti-NMDAR encephalitis associated with ovarian teratoma at our hospital, thus raising awareness of physicians.

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Section: Discussionmentioning

confidence: 99%

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

Pham

Nguyen

2023

Gynecology and Minimally Invasive Therapy

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“…In most cases, unilateral ovarian resections are performed in patients with ovarian lesions identified on appropriate imaging ( 11 , 12 ). In patients with suspected bilateral ovarian teratomas, “partial” bilateral oophorectomy may be undertaken to resect tumor tissue while preserving ovarian function ( 12 – 18 ). Despite a paucity of evidence to support their use, “blind” ovarian resections (i.e., resections performed without pre-operative imaging evidence of teratoma) and bilateral “full” oophorectomies have been performed on patients with refractory NMDARE.…”

Section: Introductionmentioning

confidence: 99%

Ovarian resection in anti-N-methyl-D-aspartate receptor encephalitis: A comparison of surgical approaches

et al. 2022

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BackgroundFor patients with anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) and ovarian teratoma, “conservative” surgical approaches (complete or partial unilateral oophorectomy or bilateral partial oophorectomies) are associated with clinical improvement. “Aggressive” ovarian resections (complete bilateral oophorectomy or “blind” ovarian resections without pre-operative evidence of teratoma) are also reported, although the evidence supporting these approaches is unclear.ObjectiveTo compare the one-year functional outcomes of patients with NMDARE who underwent conservative vs. aggressive ovarian resections.MethodsPatients with NMDARE undergoing ovarian resection between January 1st, 2012 and December 31st, 2021 were retrospectively identified from three North American tertiary care centers. Primary outcome was a modified Rankin Scale score of 0–2 one year after ovarian resection. Fisher exact and Wilcoxon rank sum tests were used to compare demographic features, disease characteristics, and functional outcomes between the two surgical groups. A fixed-effects meta-analysis of studies reporting functional outcomes based on surgical approach was also performed.ResultsTwenty-three patients were included. Eight underwent aggressive surgical management. There was a non-significant trend toward an association between aggressive surgical management and younger age-at-onset, higher baseline disease severity, and longer delays to treatment. There was no difference between “aggressive” (3/8, 38%) and “conservative” (11/15, 73%) management groups in achieving the primary outcome (OR95% = <0.1–1.9; p = 0.18). Findings were similar when considering data from 52 patients in two published studies (RR = 0.74; CI95% = 0.48–1.13; p = 0.16).ConclusionsAggressive ovarian resection was not associated with improved outcomes in patients with NMDARE in this series. Group differences may have contributed, recognizing that patients who underwent aggressive resection tended to be sicker, with procedures performed later in the disease course. Based on available evidence, we advocate for function-sparing resection in patients with imaging-confirmed/suspected teratoma, and repeated multi-modal imaging in at-risk patients with NMDARE refractory to conventional treatment.

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Anti-NMDAR encephalitis in a 19 year old female patient with ovarian teratoma: A case report

Cited by 2 publications

References 10 publications

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

Ovarian resection in anti-N-methyl-D-aspartate receptor encephalitis: A comparison of surgical approaches

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