期刊
NATURE CLINICAL PRACTICE NEUROLOGY
卷 3, 期 5, 页码 291-296出版社
NATURE PUBLISHING GROUP
DOI: 10.1038/ncpneuro0493
关键词
catatonia; NMDA receptor antibodies; ovarian teratoma; paraneoplastic encephalitis; psychosis
资金
- NCI NIH HHS [R01 CA089054, R01 CA107192-03, R01 CA089054-05, R01 CA107192, R01CA107192] Funding Source: Medline
- NINDS NIH HHS [R56 NS045986, R01 NS045986] Funding Source: Medline
Background A 34-year-old woman presented with headache, feverish sensation and anxiety, rapidly followed by homicidal ideation, aggressive agitation, seizures, hypoventilation, hyperthermia and prominent autonomic instability requiring intubation and sedation. She developed episodes of hypotension and bradycardia with periods of asystole lasting up to 15 seconds. Upon weaning off sedation, her eyes opened but she was unresponsive to stimuli. There was muscle rigidity, frequent facial grimacing, rhythmic abdominal contractions, kicking motions of the legs, and intermittent dystonic postures of the right arm. Investigations Routine laboratory testing, toxicology screening, studies for autoimmune and infectious etiologies, brain MRI scan, lumbar puncture, electroencephalogram, whole-body CT scan, abdominal ultrasound, paraneoplastic and voltage-gated potassium channel antibody serologies, analysis of N-methyl-D-aspartate receptor antibodies. Diagnosis Paraneoplastic encephalitis associated with immature teratoma of the ovary and N-methyl-D-aspartate receptor antibodies. Management Intensive care, mechanical ventilation, antiepileptics, laparotomy and left salpingo-oophorectomy, corticosteroids, plasma exchange, intravenous immunoglobulin, cyclophosphamide, physical therapy, and chemotherapy.
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