Ovarian tumor associated with anti-N-methyl-D-aspartate receptor encephalitis: A report of 110 cases

Objective To summarize the clinical features of patients with ovarian tumor associated anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis, and to explore the influence of operation patterns on the prognosis. Methods The clinical data of ovarian tumors with anti-NMDAR encephalitis in the Third Affiliated Hospital of Sun Yat-sen University from January 2009 to December 2018 were collected, and the clinical characteristics, treatment and prognosis were analyzed. Results A total of 110 patients with ovarian tumors and anti-NMDAR encephalitis were collected. All patients were positive for anti-NMDAR antibodies in serum and/or cerebrospinal fluid. The age of onset ranged from 10 to 35 years (24.6±5.7). About 60.9% patients' initial symptom was psychosis. The main clinical features were psychosis (97.3%), seizures (83.6%), conscious disturbance (72.7%), autonomic dysfunction (64.5%), dyskinesia (64.5%), central hypoventilation (54.5%) and impaired memory (31.8%). Most patients' symptoms were relieved after surgery and immunotherapy. Postoperative pathological results revealed that ovarian teratoma accounted for 97.8% of the ovarian tumor. The prognosis of patients with surgery was better than the patients without surgery, with statistically significant difference (P<0.05). The prognosis of patients with adnexectomy was better than the patients with ovarian tumor excision , with statistically significant difference (P<0.05). Conclusions Anti-NMDAR encephalitis, with psycho-neurological symptoms as dominant manifestation, is usually associated with ovarian tumor. For young female patients with psychosis, clinicians should be alert to the possibility of anti-NMDAR encephalitis and screen for tumor. Patients with adnexectomy and immunotherapy can get a better prognosis. Key words: Ovarian neoplasms; Anti-N-methyl-D-aspartate receptor encephalitis; Prognosis