Two cases of Anti-N-methyl-D-aspartate(NMDA)-receptor encephalitis associated with ovarian teratoma treated by laparoscopic surgery

Abstract

　Anti-N-methyl-D-aspartate (NMDA)-receptor encephalitis is a paraneoplastic syndrome encountered by obstetricians and gynecologists. Anti-NMDA-receptor encephalitis is a limbic encephalitis commonly seen in young females who present with various symptoms including psychiatric disturbance, changes in consciousness, and involuntary movements. Ovarian teratoma is found in approximately half of all cases of anti-NMDA-receptor encephalitis, and early tumor removal is considered important. We experienced two cases of acute encephalitis. Upon examination, we suspected ovarian teratoma and performed laparoscopic surgery. In case 1, surgery was performed on day 143 after onset; however, postoperative improvement was slow. The patient (Case 1) was extubated on postoperative day 71 and was discharged on postoperative day 374. For another patient (Case 2), surgery was performed on day 24 after onset. The patient was extubated on postoperative day 23 and was discharged on postoperative day 67. Neither patients experienced recurrence of encephalitis; however, the case 2 patient continues to exhibit limb contracture as a disease sequelae. These cases reinforce the importance of early tumor resection.