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CASE REPORT
Neurogenic bladder in an adolescent woman with an ovarian tumour: an unusual presentation of anti-NMDA-receptor encephalitis
  1. Natasha Soong-Ying Liou and
  2. Fredric Willmott
  1. Department of Obstetrics and Gynaecology, Whipps Cross University Hospital, Bart’s Health Trust, London, UK
  1. Correspondence to Dr Natasha Soong-Ying Liou, natasha.liou{at}gmail.com

Abstract

Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is rarely seen in women with ovarian teratoma. It is characterised by neuropsychiatric symptoms and may also cause autonomic imbalance. We present the case of a 16-year-old nulliparous woman who presented with an acute history of seizures and neurogenic bladder. Antiviral and antiepileptic therapy conferred no therapeutic benefit. A cystic pelvic mass measuring 185×140×92 mm was identified separate from the bladder. Serum titres of NMDA receptor antibodies were significantly elevated. The mass was surgically removed and histology revealed benign ovarian teratoma with NMDA receptors. The patient made a rapid improvement and had full resolution of urinary and neuropsychiatric symptoms within 1 year. This case demonstrates that increased awareness in adolescents is crucial for avoiding symptom dismissal, misdiagnosis and inappropriate treatment of this condition. Surgical removal of the teratoma should be the first line therapy of anti-NMDA-receptor encephalitis as this often leads to symptom resolution soon after.

  • epilepsy and seizures
  • paediatric oncology
  • child and adolescent psychiatry (paediatrics)
  • cancer - see oncology
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Footnotes

  • Contributors FW was the primary clinician for the care of the patient. NS-YL performed the literature review and wrote the manuscript. FW and NS-YL read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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