Abstract
Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is one of the paraneoplastic encephalitides and is associated with ovarian teratoma. A 33-year-old woman presented with headache and abnormal behavior. Because an acute psychosis was suspected, she was initially admitted to psychiatry. A few days later, she developed confusion, auditory hallucinations, and catalepsy. Furthermore, she showed unresponsiveness, fever, and involuntary movement. She required airway management because of hypertonia and bleeding of the tongue. She was then transferred to the neurology department of our hospital. Her brain imaging and whole body CT scan were normal. Non-herpetic encephalitis was suspected based on her blood and cerebrospinal fluid (CSF) examinations and clinical findings. Intensive care, including ventilatory support and steroid pulse therapy, was performed. Although she was taken off the ventilator 40 days after admission, higher brain dysfunction remained. Therefore, a second CT scan was performed, and a left ovarian teratoma that was not previously seen was identified. Anti-NMDAR encephalitis was suspected, and she was referred to gynecology for tumor resection. She underwent a single incision laparoscopic salpingo-oophorectomy 78 days after admission. Usual postoperative management was performed, though the patient was seen to perform wound curettage by herself immediately after surgery. Her higher brain dysfunction recovered gradually and was almost normal one year after surgery. Antibodies against NMDAR were positive in the CSF and blood. In terms of postoperative management, single incision laparoscopic surgery may be appropriate surgical approach in patients with anti-NMDAR encephalitis because communication with such patients is often difficult immediately after surgery.
