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Reversible limbic encephalitis caused by ovarian teratoma
Author(s) -
Nokura K.,
Yamamoto H.,
Okawara Y.,
Koga H.,
Osawa H.,
Sakai K.
Publication year - 1997
Publication title -
acta neurologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.967
H-Index - 95
eISSN - 1600-0404
pISSN - 0001-6314
DOI - 10.1111/j.1600-0404.1997.tb00227.x
Subject(s) - medicine , limbic encephalitis , pathology , encephalitis , sequela , teratoma , immunology , surgery , virus
A 19‐year‐old woman developed memory loss followed by psychosis, coma, convulsion, and central hypoventilation requiring mechanical ventilation. MRI of the brain showed minimal changes, and SPECT imaging revealed a small region of increased uptake in the cortex. Intravenous acyclovir and high‐dose corticosteroids were administered without any effect. An extensive work‐up revealed an elevated serum alpha‐fetoprotein (AFP) concentration and the presence of an ovarian tumor. Following resection of the tumor, an immature teratoma by pathology, the patient had significant recovery of her cognitive function with some psychotic sequela. Serum anti‐neuronal antibody (anti‐Hu) was negative both by immunohistochemistry and by Western blot analysis. A rare combination of paraneoplastic limbic encephalitis and brainstem encephalitis was the suspected diagnosis. Because the tumor contained a neuronal component, we propose an immunologic cross‐reaction as the pathomechanism, but the lack of a specific antibody may suggest cell‐mediated rather than globulin‐mediated immunity.