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Arch Gynecol Obstet ; 302(2): 315-320, 2020 08.
Article in English | MEDLINE | ID: mdl-32556515

ABSTRACT

BACKGROUND: Anti-NMDA receptor antibody (anti-NMDAr) encephalitis, although still a rare condition, is well known to neurologists as it is the leading cause of non-infectious acute encephalitis in young women. However, this is less well known to gynecologists, who may have a decisive role in etiological management. Indeed, in 30-60% of cases in women of childbearing age, it is associated with the presence of an ovarian teratoma, whose removal is crucial in the resolution of symptomatology. OBJECTIVES: Primary objective of our work was to present a review in a very schematic and practical way for gynecologists, about the data on anti-NMDAr encephalitis in terms of epidemiology, clinical symptomatology, treatment and prognosis. The second objective was to propose a decision tree for gynecologists to guide them, in collaboration with neurologists and anesthesiologists, after the diagnosis of NMDAr encephalitis associated with an ovarian mass. METHOD: We conducted an exhaustive review of existing data using PubMed and The Cochrane Library. Then, we illustrated this topic by presenting two typical cases from our experience. RESULTS: Anti-NMDA antibody encephalitis association with an ovarian teratoma is common, especially in women of reproductive age. Complementary examinations in search of an ovarian teratoma must therefore be systematic to envisage a possible surgical excision that may improve patient prognosis. CONCLUSION: Anti-NMDA antibody encephalitis should not be ignored by gynecologists whose role in management is central.


Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis , Antibodies/cerebrospinal fluid , Ovarian Neoplasms/complications , Receptors, N-Methyl-D-Aspartate/immunology , Teratoma/complications , Adult , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/epidemiology , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/therapy , Female , Humans , Ovarian Neoplasms/pathology , Ovarian Neoplasms/surgery , Physical Examination , Prognosis , Reproduction , Teratoma/pathology , Teratoma/surgery , Young Adult
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