[Autoimmune limbic encephalitis with anti-NMDA receptor antibodies and ovarian teratoma: a treatable form of paraneoplastic limbic encephalitis]

Abstract

Introduction: The first French-language case of limbic encephalitis due to anti-N-methyl-D-aspartate receptor to glutamate (NMDA-R) antibodies associated with an ovarian teratoma is reported.

Clinical case: A 35-year-old woman presented with a subacute severe anterograde memory deficit, psychiatric disturbances and generalized seizures associated with an ovarian teratoma. No abnormality was noticed on the two successive MRI. The cerebrospinal fluid showed mild lymphocytosis and elevation of protein concentration. The search for classical onconeuronal antibodies in the serum was negative. Total body computed tomographic scan disclosed a five centimeter long ovarian cyst. Pathology found an ovarian teratoma containing a small immature neuroepithelial component. Complete tumor resection associated with high doses of intravenous methylprednisolone and intravenous polyvalent immunoglobulins allowed her clinical state to improve as soon as three days after surgery. Full recovery was noted four months later. Serum anti-NMDA-R antibodies were positive.

Conclusion: Owing to the recent description of the association between anti-NMDA-R and limbic encephalitis and the frequent good prognosis reported in the available series and case reports, it is important to search for this association in the not so rare cases of limbic encephalitis when no other cause is disclosed.