Neurogenic bladder in an adolescent woman with an ovarian tumour: an unusual presentation of anti-NMDA-receptor encephalitis.

BMJ Case Reports
Natasha Soong-Ying Liou, Fredric Willmott

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is rarely seen in women with ovarian teratoma. It is characterised by neuropsychiatric symptoms and may also cause autonomic imbalance. We present the case of a 16-year-old nulliparous woman who presented with an acute history of seizures and neurogenic bladder. Antiviral and antiepileptic therapy conferred no therapeutic benefit. A cystic pelvic mass measuring 185×140×92 mm was identified separate from the bladder. Serum titres of NMDA receptor antibodies were significantly elevated. The mass was surgically removed and histology revealed benign ovarian teratoma with NMDA receptors. The patient made a rapid improvement and had full resolution of urinary and neuropsychiatric symptoms within 1 year. This case demonstrates that increased awareness in adolescents is crucial for avoiding symptom dismissal, misdiagnosis and inappropriate treatment of this condition. Surgical removal of the teratoma should be the first line therapy of anti-NMDA-receptor encephalitis as this often leads to symptom resolution soon after.

References

Aug 12, 2009·Annals of Neurology·Nicole R FloranceJosep Dalmau
Apr 30, 2010·The Journal of Neuroscience : the Official Journal of the Society for Neuroscience·Ethan G HughesRita J Balice-Gordon
Oct 19, 2010·Journal of Neuroimmunology·Klaus-Peter WandingerJosep Dalmau
May 1, 2012·Brain : a Journal of Neurology·Lenka MikasovaLaurent Groc
Jan 23, 2016·Gynecologic Oncology Reports·Jennifer A BravermanRuchi Garg

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Citations

Aug 17, 2021·The Journal of Obstetrics and Gynaecology Research·Jiaxin GuRuiqi Duan

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Anti-N-Methyl-D-Aspartate Receptor Encephalitis

Anti-N-Methyl-D-Aspartate (NMDA) receptor encephalitis is a form of of brain inflammation due to antibodies against NMDA receptors. Discover the latest research on anti-NMDA receptor encephalitis here.

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