EC Gynaecology

Introduction: Anti NDMAR encephalitis is relatively common autoimmune encephalitis characterized by complex neuropsychiatric feature and the presence of immunoglobulin G {IgG} antibodies against the NR1 subunit of the NDMA receptors in the central nervous system.

Case Report: This is a case of a 53-year-old woman who had small ovarian teratoma. She presented to the hospital with complaint of right lower abdominal pain. Ultrasound examination showed presence of dermoid cyst measuring 2.5 cm by 2.5 cm in the right ovary and no evidence of torsion.

She presented the second time with severe manifestations including fever, focal seizure, incoherent speech followed by onset of generalized tonic-clonic convulsion lasting for five minutes which progressed to status epilepticus. She was then sedated and intubated. Her medical history included hypertension and hypercholesterolemia and no history of epilepsy.

Investigations like full blood counts (FBC), white cell count (WCC) and inflammatory markers were unremarkable. Lumbar puncture and MRI brain showed autoimmune encephalitis whereas CT head scan did not show signs of intracranial bleedings. The presence of NMDAR antibodies was confirmed by serum testing.

Autoimmune encephalitis was diagnosed by NMDAR antibody triggered by an ovarian teratoma. Surgical intervention was decided upon by a multidisciplinary team involving gynecology, MICU, and neurology. 3 cm x 3 cm right ovarian dermoid cyst found during laparoscopy and the patient underwent laparoscopic bilateral salpingo-oophorectomy.

Postoperatively, the patient was continuously convulsing for which she was sedated, but gradually improved but frequent facial and right-hand twitch remain.

MRI repeated 2 months after surgery show no residual tumor.

She was discharged to rehabilitation with poor Glasgow coma scale of 3, tracheostomized on naso gastric tube for feeding.

Conclusion: The association of ovarian teratoma anti-NDMAR encephalitis is a serious and potentially fatal pathology. Heightened recognition of cognitive and behavioural change, diagnosis through TVU and subsequent tumor removal in addition to diagnostic confirmation through the presence of anti-NDMAR antibodies must be emphasized.

 Keywords: Autoimmune Encephalitis; Ovarian Teratoma; Anti-NDMAR Antibodies

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