Anti-NMDA Receptor Paraneoplastic Encephalitis: An Important Differential Diagnosis in Subacute Psychosis

Abstract

Anti NMDA (N-methyl D-aspartate) receptor encephalitis has been recently described in young women with ovarian teratoma. Memory and psychiatric disturbances are frequent followed by respiratory and autonomic failure warranting long intensive care admissions. We report on a female patient with paraneoplastic encephalitis manifested by behavioural changes and neurological impairment, followed by respiratory and hemodynamic instability. Anti-NMDA receptor antibodies were found in blood and spinal fluid in association with an imamature grade 2 ovarian teratoma. She made a full recovery after complete oophorectomy and institution of intravenous immunoglobulin and corticosteroids. Anti-NMDA encephali-tis should be considered in any female patient presenting with de novo psychiatric symptoms. As in other paraneoplastic syndrome, its therapy is based in resection of the underlying tumor associated with immunomodulators. Timely initiation of therapy may significantly improve outcome as in this case.