Anti N-Methyl-D-Aspartate Receptor (NMDR) encephalitis in a 28-year old female with ovarian follicular cyst presenting with status epilepticus

ABSTRACT

@#Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a potentially fatal autoimmune condition where antibodies are produced and destroy NMDA receptors in the brain, thereby causing profound dysfunctional neurotransmission. This rare disease is often associated with a tumor, usually a teratoma. A 28-year-old female previously diagnosed with seizure disorder presented with chronic history of neuropsychiatric symptoms leading to status epilepticus on the day of confinement. Investigation showed the presence of anti-NMDAR antibodies both in serum and cerebrospinal fluid. A right ovarian cyst was noted on ultrasound. Methylprednisolone and immunoglobulin were given followed by surgical removal of the ovarian cyst. Histopathology result showed a follicular cyst. The patient was discharged improved, and remained asymptomatic and seizure free. Repeat serum NMDAR antibody test was negative. Early diagnosis and prompt treatment of patients with NMDA receptor encephalitis is lifesaving. Although mostly associated with an ovarian teratoma, the case reported a possible link between NMDAR encephalitis and benign ovarian cysts.