A patient with encephalitis associated with NMDA receptor antibodies

Lauren H. Sansing, Erdem Tüzün, Melissa W. Ko, Jennifer Baccon, David R. Lynch, Josep Dalmau

Research output: Contribution to journalArticle

187 Citations (Scopus)

Abstract

Background: A 34-year-old woman presented with headache, feverish sensation and anxiety, rapidly followed by homicidal ideation, aggressive agitation, seizures, hypoventilation, hyperthermia and prominent autonomic instability requiring intubation and sedation. She developed episodes of hypotension and bradycardia with periods of asystole lasting up to 15 seconds. Upon weaning off sedation, her eyes opened but she was unresponsive to stimuli. There was muscle rigidity, frequent facial grimacing, rhythmic abdominal contractions, kicking motions of the legs, and intermittent dystonic postures of the right arm. Investigations: Routine laboratory testing, toxicology screening, studies for autoimmune and infectious etiologies, brain MRI scan, lumbar puncture, electroencephalogram, whole-body CT scan, abdominal ultrasound, paraneoplastic and voltage-gated potassium channel antibody serologies, analysis of N-methyl-D-aspartate receptor antibodies. Diagnosis: Paraneoplastic encephalitis associated with immature teratoma of the ovary and N-methyl-D-aspartate receptor antibodies. Management: Intensive care, mechanical ventilation, antiepileptics, laparotomy and left salpingo-oophorectomy, corticosteroids, plasma exchange, intravenous immunoglobulin, cyclophosphamide, physical therapy, and chemotherapy.

Original languageEnglish (US)
Pages (from-to)291-296
Number of pages6
JournalNature Clinical Practice Neurology
Volume3
Issue number5
DOIs
StatePublished - May 1 2007

Fingerprint

Encephalitis
N-Methyl-D-Aspartate Receptors
Antibodies
Muscle Rigidity
Voltage-Gated Potassium Channels
Whole Body Imaging
Hypoventilation
Plasma Exchange
Spinal Puncture
Intravenous Immunoglobulins
Teratoma
Ovariectomy
Serology
Critical Care
Bradycardia
Weaning
Heart Arrest
Posture
Artificial Respiration
Intubation

All Science Journal Classification (ASJC) codes

  • Clinical Neurology
  • Cellular and Molecular Neuroscience

Cite this

Sansing, L. H., Tüzün, E., Ko, M. W., Baccon, J., Lynch, D. R., & Dalmau, J. (2007). A patient with encephalitis associated with NMDA receptor antibodies. Nature Clinical Practice Neurology, 3(5), 291-296. https://doi.org/10.1038/ncpneuro0493
Sansing, Lauren H. ; Tüzün, Erdem ; Ko, Melissa W. ; Baccon, Jennifer ; Lynch, David R. ; Dalmau, Josep. / A patient with encephalitis associated with NMDA receptor antibodies. In: Nature Clinical Practice Neurology. 2007 ; Vol. 3, No. 5. pp. 291-296.
@article{933e9435ad674b55b6556195e5514cfd,
title = "A patient with encephalitis associated with NMDA receptor antibodies",
abstract = "Background: A 34-year-old woman presented with headache, feverish sensation and anxiety, rapidly followed by homicidal ideation, aggressive agitation, seizures, hypoventilation, hyperthermia and prominent autonomic instability requiring intubation and sedation. She developed episodes of hypotension and bradycardia with periods of asystole lasting up to 15 seconds. Upon weaning off sedation, her eyes opened but she was unresponsive to stimuli. There was muscle rigidity, frequent facial grimacing, rhythmic abdominal contractions, kicking motions of the legs, and intermittent dystonic postures of the right arm. Investigations: Routine laboratory testing, toxicology screening, studies for autoimmune and infectious etiologies, brain MRI scan, lumbar puncture, electroencephalogram, whole-body CT scan, abdominal ultrasound, paraneoplastic and voltage-gated potassium channel antibody serologies, analysis of N-methyl-D-aspartate receptor antibodies. Diagnosis: Paraneoplastic encephalitis associated with immature teratoma of the ovary and N-methyl-D-aspartate receptor antibodies. Management: Intensive care, mechanical ventilation, antiepileptics, laparotomy and left salpingo-oophorectomy, corticosteroids, plasma exchange, intravenous immunoglobulin, cyclophosphamide, physical therapy, and chemotherapy.",
author = "Sansing, {Lauren H.} and Erdem T{\"u}z{\"u}n and Ko, {Melissa W.} and Jennifer Baccon and Lynch, {David R.} and Josep Dalmau",
year = "2007",
month = "5",
day = "1",
doi = "10.1038/ncpneuro0493",
language = "English (US)",
volume = "3",
pages = "291--296",
journal = "Nature Reviews Neurology",
issn = "1759-4758",
publisher = "Nature Publishing Group",
number = "5",

}

Sansing, LH, Tüzün, E, Ko, MW, Baccon, J, Lynch, DR & Dalmau, J 2007, 'A patient with encephalitis associated with NMDA receptor antibodies', Nature Clinical Practice Neurology, vol. 3, no. 5, pp. 291-296. https://doi.org/10.1038/ncpneuro0493

A patient with encephalitis associated with NMDA receptor antibodies. / Sansing, Lauren H.; Tüzün, Erdem; Ko, Melissa W.; Baccon, Jennifer; Lynch, David R.; Dalmau, Josep.

In: Nature Clinical Practice Neurology, Vol. 3, No. 5, 01.05.2007, p. 291-296.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A patient with encephalitis associated with NMDA receptor antibodies

AU - Sansing, Lauren H.

AU - Tüzün, Erdem

AU - Ko, Melissa W.

AU - Baccon, Jennifer

AU - Lynch, David R.

AU - Dalmau, Josep

PY - 2007/5/1

Y1 - 2007/5/1

N2 - Background: A 34-year-old woman presented with headache, feverish sensation and anxiety, rapidly followed by homicidal ideation, aggressive agitation, seizures, hypoventilation, hyperthermia and prominent autonomic instability requiring intubation and sedation. She developed episodes of hypotension and bradycardia with periods of asystole lasting up to 15 seconds. Upon weaning off sedation, her eyes opened but she was unresponsive to stimuli. There was muscle rigidity, frequent facial grimacing, rhythmic abdominal contractions, kicking motions of the legs, and intermittent dystonic postures of the right arm. Investigations: Routine laboratory testing, toxicology screening, studies for autoimmune and infectious etiologies, brain MRI scan, lumbar puncture, electroencephalogram, whole-body CT scan, abdominal ultrasound, paraneoplastic and voltage-gated potassium channel antibody serologies, analysis of N-methyl-D-aspartate receptor antibodies. Diagnosis: Paraneoplastic encephalitis associated with immature teratoma of the ovary and N-methyl-D-aspartate receptor antibodies. Management: Intensive care, mechanical ventilation, antiepileptics, laparotomy and left salpingo-oophorectomy, corticosteroids, plasma exchange, intravenous immunoglobulin, cyclophosphamide, physical therapy, and chemotherapy.

AB - Background: A 34-year-old woman presented with headache, feverish sensation and anxiety, rapidly followed by homicidal ideation, aggressive agitation, seizures, hypoventilation, hyperthermia and prominent autonomic instability requiring intubation and sedation. She developed episodes of hypotension and bradycardia with periods of asystole lasting up to 15 seconds. Upon weaning off sedation, her eyes opened but she was unresponsive to stimuli. There was muscle rigidity, frequent facial grimacing, rhythmic abdominal contractions, kicking motions of the legs, and intermittent dystonic postures of the right arm. Investigations: Routine laboratory testing, toxicology screening, studies for autoimmune and infectious etiologies, brain MRI scan, lumbar puncture, electroencephalogram, whole-body CT scan, abdominal ultrasound, paraneoplastic and voltage-gated potassium channel antibody serologies, analysis of N-methyl-D-aspartate receptor antibodies. Diagnosis: Paraneoplastic encephalitis associated with immature teratoma of the ovary and N-methyl-D-aspartate receptor antibodies. Management: Intensive care, mechanical ventilation, antiepileptics, laparotomy and left salpingo-oophorectomy, corticosteroids, plasma exchange, intravenous immunoglobulin, cyclophosphamide, physical therapy, and chemotherapy.

UR - http://www.scopus.com/inward/record.url?scp=34248551269&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34248551269&partnerID=8YFLogxK

U2 - 10.1038/ncpneuro0493

DO - 10.1038/ncpneuro0493

M3 - Article

C2 - 17479076

AN - SCOPUS:34248551269

VL - 3

SP - 291

EP - 296

JO - Nature Reviews Neurology

JF - Nature Reviews Neurology

SN - 1759-4758

IS - 5

ER -