ABSTRACT
N-methyl-D-aspartate receptor encephalitis is an autoimmune encephalitis relationated or not with a neoplasm. Although its incidence is unknown, probably remains underdiagnosed. Epidemiological studies place it as the second cause of immune-mediated encephalitis and the first in patients aged less of 30 years. It shows neuropsychiatric symptoms and autonomic instability. After diagnosis, based on the detection of antibodies in serum or cerebrospinal fluid, an occult malignancy must be investigated. While increasing number of cases have been diagnosed and the important role of this receptor in general anesthesia mechanisms, the interaction of the disease with anesthetic agents and perioperative stress is unknown. We describe the case of a patient with encephalitis associated to ovarian teratoma that underwent gynaecological laparoscopy.
Subject(s)
Anesthesia, Intravenous , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/etiology , Ovarian Neoplasms/complications , Ovariectomy , Teratoma/complications , Adult , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/drug therapy , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/psychology , Consciousness Disorders/etiology , Contraindications , Diagnostic Errors , Epilepsy, Tonic-Clonic/etiology , Female , Fentanyl , Humans , Ketamine , Mental Disorders/diagnosis , Mental Disorders/etiology , Nitrous Oxide , Ovarian Neoplasms/immunology , Ovarian Neoplasms/surgery , Propofol , Psychotic Disorders/diagnosis , Rituximab/therapeutic use , Teratoma/immunology , Teratoma/surgeryABSTRACT
Negative pressure pulmonary edema is a complication, described since 1977, caused by upper airway obstruction in both children and adults. Although its aetiopathogeny is multifactorial, especially outstanding is excessive negative intrathoracic pressure caused by the forced spontaneous inspiration of a patient against a closed glottis, that causes high arteriole and capillary fluid pressures that favor transudation into the alveolar space The resulting pulmonary edema can appear a few minutes after the obstruction of the airway or in a deferred way after several hours. The clinical manifestations are potentially serious, but normally respond well to treatment with supplemental oxygen, positive pressure mechanical ventilation and diuretics. Diagnostic suspicion is important for acting promptly. We report three clinical cases with acute negative pressure pulmonary edema.
