Limbic Encephalitis Presenting With Seizures, Anterograde Amnesia, and Psychosis in a Patient Seven Weeks Status Post Immature Ovarian Teratoma Removal
Limbic Encephalitis Presenting With Seizures, Anterograde Amnesia, and Psychosis in a Patient Seven Weeks Status Post Immature Ovarian Teratoma Removal
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DOI：
10.7205/milmed-d-09-00250
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发表时间：
2010-08-01
影响因子：
1.2
通讯作者：
Loeffler, George
中科院分区：
文献类型：
--
作者：
Kleyensteuber, Brian;Ruterbusch, Victor;Loeffler, George
与抗N-甲基-D-谷氨酸（NMDA）受体相关的副肿瘤综合征最初可表现为神经或精神障碍。切除肿瘤通常是治愈性的，并且该综合征与肿瘤的存在有关，而不是与肿瘤病史有关。我们提出了一个案例，其中一个25岁的西班牙裔妇女癫痫发作，记忆丧失，和不寻常的行为变化。这名妇女在2个月前切除了一个畸胎瘤。由于时间进程，最初认为不太可能出现副肿瘤综合征。脑成像、脑电图（EEG）和神经系统检查均为阴性。患者因疑似躯体形式障碍和精神病接受治疗。根据临床表现，工作诊断改为副肿瘤性边缘叶脑炎所致谵妄。给予静脉注射免疫球蛋白（IVIg）和高剂量类固醇。患者症状改善，出院回家。出院后，研究结果显示NMDA受体NR 1/NR 2抗体阳性。
A paraneoplastic syndrome associated with anti-N-methyl-D-asparate (NMDA) receptors can initially present as a neurologic or psychiatric disturbance. Removal of the tumor is usually curative, and the syndrome is associated with the presence, rather than the history, of tumor. We present a case in which a 25-year-old, Hispanic woman presented with seizures, memory loss, and unusual behavioral changes. The woman had a teratoma removed 2 months earlier. Because of the time course, a paraneoplastic syndrome was initially considered unlikely. Brain imaging, electroencephalography (EEG) and neurologic work-up were negative. The patient was treated for a suspected somatoform disorder and psychosis. Based on the clinical picture, the working diagnosis was changed to delirium due to paraneoplastic limbic encephalitis. A course of intravenous immunoglobins (IVIg), and high dose steroids was administered. The patient's symptoms improved, and she was discharged home. After discharge, studies came back positive for antibodies against NR1/NR2 of the NMDA receptor.