A patient with mediastinal mature teratoma presenting with paraneoplastic limbic encephalitis.

摘要

A 22-year-old woman with a convulsion and impaired consciousness was transferred from a local psychiatric clinic to Oita University Hospital. She had no symptoms until July 2004, when she had fever and convulsive seizures and was diagnosed encephalitis. She underwent continuous infusion of thiamylal sodium for status epilepticus. Autonomic changes, such as tachycardia and increased sweating, were also seen.On neurological examination, she was in coma and status epilepticus, showing spastic paralysis and central hy-poventilation. Tracheal intubation was performed, and she was put on mechanical ventilation.There were no evident endocrine or metabolic abnormalities. Antinuclear antibodies were negative. Her cerebro-spinal fluid (CSF) pressure was 270 mm H_2O. The fluid was clear and contained 26 cells/mul, glucose 72 mg/dl, protein 21.6 mg/ml, immunoglobulin G 6 mg/dl, and adenosine deaminase 1.5 IU/L. Microscopic examinations of the CSF for tumor cells and microorganisms were negative, and cultures yielded no growth. There were no marked elevations of antiviral antibody titers, including Epstein-Barr virus, herpes simplex virus, echo virus, and cytomegalovirus. A subunit of anti-7V-methyl-D-aspartate receptor antibodies, anti-NR2B (glutamate receptor [GluR] epsilon-2) antibody, and anti-NR2A (glutamate receptors [GluR] epsilon-1) antibody were positive in both serum and CSF.