Paraneoplastic anti-N-methyl-d-aspartate-receptor encephalitis from mature cystic teratoma.

摘要

A 20-year-old nullipara with no significant medical history presented to a local emergency department with complaint of severe headache. She was diagnosed with migraine headaches, treated, and discharged. Three days later, she re-presented with persistent and worsening headaches, memory deficit, and altered mental status. In the emergency department, she became agitated and confused and was admitted for overnight observation. She then developed generalized tonic clonic seizures and ultimately required intensive care unit (ICU) admission, intubation, sedation, and daily anti-epileptic therapy. Neu- rologic workup was performed including routine laboratory tests, lumbar puncture, magnetic resonance imaging of the head, and continuous electroencephalogram. Study results were negative for infectious encephalitis, intracranial mass, and epilepsy. Computed tomography of the abdomen and pelvis revealed a 1-cm left adnexal hypodensity consistent with possible dermoid cyst.