We report a 26-year-old woman with no relevant familial or personal antecedents who developed psychiatric symptoms following of delirium, fever (39°C), dysarthria, disorientation, generalized convulsive fits. EEG at entry showed slow background activity with periodic lateralized epileptiform discharges (PLEDS) on the left hemisphere. The MRI showed light and non specific abnormalities in the white matter of both hemispheres. CSF examination was normal. A few days later: akinetic mutism, pharmacoresistant partial seizures and central hypoventilation. Transferred on ICU: assisted ventilation, treatment with antiepileptic drugs, steroids and i.v IgG. Test for serum anti NMDAR-Abs gave positive results. Three weeks after entry: progressive improvement of respiratory and neurological status,but appearance of marked psychomotor agitation.A total body CT disclosed a left ovarian teratoma.On Avril 2008 she had an ovariectomy. Histology confirmed an ovarian teratoma.We conclude that paraneoplastic anti-NMDAR-ab encephalitis should be suspected in young woman presenting with febrile epileptogenic encephalopathy followed by severe psychomotor agitation.
Epileptic seizures followed by severe psychomotor agitation during paraneoplastic anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma: A case report
Aguglia U
2008-01-01
Abstract
We report a 26-year-old woman with no relevant familial or personal antecedents who developed psychiatric symptoms following of delirium, fever (39°C), dysarthria, disorientation, generalized convulsive fits. EEG at entry showed slow background activity with periodic lateralized epileptiform discharges (PLEDS) on the left hemisphere. The MRI showed light and non specific abnormalities in the white matter of both hemispheres. CSF examination was normal. A few days later: akinetic mutism, pharmacoresistant partial seizures and central hypoventilation. Transferred on ICU: assisted ventilation, treatment with antiepileptic drugs, steroids and i.v IgG. Test for serum anti NMDAR-Abs gave positive results. Three weeks after entry: progressive improvement of respiratory and neurological status,but appearance of marked psychomotor agitation.A total body CT disclosed a left ovarian teratoma.On Avril 2008 she had an ovariectomy. Histology confirmed an ovarian teratoma.We conclude that paraneoplastic anti-NMDAR-ab encephalitis should be suspected in young woman presenting with febrile epileptogenic encephalopathy followed by severe psychomotor agitation.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
