| ObjectiveOvarian teratoma-associated limbic encephalitis(OTLE) is a special type of paraneoplastic limbic encephalitis with ovarian teratoma[1],which can lead to serious neurological psychiatric symptoms[2] or even death.It is caused by ovarian teratoma [1],with long distance, non-metastatic complications of peripheral nervous system. OTLE is rare in clinic.Its symptoms are serious and it is difficult to make a accurate diagnosis. Fortunately, once the diagnosis was confirmed,we can treat it with some methods such an surgical operation, immunotherapy, chemotherapy and so on. It achieved good results or even was completely cured [3].All of these make the paraneoplastic limbic encephalitis gained more and more attentions.Therefore,it is necessary to summarize the clinical manifestation,diagnosis, differential diagnosis, clinical treatment and prognosis of the OTLE in order to improve clinicians’cognition and attention of clinicians.Early diagnosis and appropriate therapy can alleviate some suffering of patients and improve the clinical prognosis.MethodWe retrospectively analyzed the clinical data of1case suffered from the anti-NMDAR encephalitis associated with immature teratoma.This case was collected from gynecology department from the Second Affiliated Hospital of Shandong University in July,2013.Combining with this successful case of the diagnosis and treatment, we found out some literatures related with OTLE which was previously reported and analyzed the incidence,clinical manifestation,auxiliary examination,diagnosis and treatment and prognosis, to raise awareness. Early detection of the primary tumor is helpful to clinical diagnosis and treatment.ResultsThis patient is a30-year-old woman, the first neuropsychiatric symptoms were consciousness disorder, epilepsy and some involuntary movements.Physical examination cooperation was bad.Her emotion was instable, speech was clear,but can not communicate with others.Orbit pressure reflex and pupillary light reflex were existent.Her mouth chewed involuntarily. She had a swallowing act and pain perception.Cardiopulmonary examination showed no obvious abnormality.Her abdomen was intumescent and a huge mass was found in the right side with a bad activity.There was a drum sound around the navel.Shifting dullness was existent.All limbs can free move with muscle strength grade IV and muscle tension level III.Her neck was soft.Physiological reflexes were existent without any pathological ones.Gynecologic examination was not done because of her incompatibility.B-ultrasound showed mixed echoes on the right side of the abdominal cavity.Abdominal plain and enhanced CT showed a huge heterogeneous density, with malignant teratoma first considered.Brain MR scan showed lacunar cerebral infarction in anterior horn of the left lateral ventricle side.The patient had a different raised level of CA19-9, CA125, CA242, and CA50. D-dimer was697ug/L.anti-N-methyl-D-aspartate receptor antibodies in serum was positive and other related examination showed no obvious abnormality.After accept perfect relevant examination and an operation,she was diagnosed as Ovarian immature teratoma IIIc and anti-N-methyl-D-aspartate Receptor encephalitis. After the operation,she accepted immunotherapy, and chemotherapy.Finally achieved the good effect and was almost healed.Conclusion OTLE is a rare PNS with neuropsychic symptoms as initial manifestations.Its main symptoms includes:personality changes, irritability,depression, seizures, memory loss, dementia, schizophrenia symptoms and sleep disturbances.If left undiagnosed,patients may develop progressive unresponsiveness,central hypoventilation,autonomic instability (fluctuations in blood pressure, temperature, and cardiac rhythm), oro-facial dyskinesias, and limb choreoathetosis and dystonia[4]. To make a firm diagnosis is difficult because clinical markers are often lacking, and symptoms usually precede the diagnosis of cancer or mimic other complications.In clinical,early diagnosis for operation treatment is the key treatment to the disease,though the clinical manifestation is serious, even need mechanical ventilation. But once diagnosed, early operation resection of the tumor combined with immune therapy or chemotherapy can improve clinical symptoms and it is significant in the final rehabilitation[5,7].When we deals with a woman with unexplained clinical encounter spirit, neuropsychiatric symptoms, paraneoplastic disease should be suspected. Careful medical examination to screen gynecologic tumor and testing of related characteristics of antibody can help clinicians make an early diagnosis. |
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