Abstract
Anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis is a rare clinical entity that typically presents with psychiatric disturbances and neurological deficits. It is commonly associated with ovarian teratomas. Although these patients demonstrate a predilection to develop cardiac arrhythmias, such complications are frequently self-limited. We chronicle here a unique case of a young woman with adnexal teratoma who experienced a tonic-clonic seizure and cardiac arrest. Electrocardiogram showed polymorphic ventricular tachycardia, consistent with torsade de pointes. Based on extensive diagnostic workup and exclusion of probable etiologies, she was diagnosed with anti-NMDA receptor encephalitis. To the best of our knowledge, this report represents the first case of anti-NMDA receptor encephalitis complicated by ictal torsades de pointes, leading to cardiac arrest. This paper illustrates that patients with anti-NMDA receptor encephalitis can develop life-threatening cardiac dysrhythmia and cardiac arrest, requiring urgent management. Clinicians should be vigilant for severe autonomic dysfunction as prompt etiology establishment is of paramount importance in these patients.
Highlights
In 2007, Dalmau et al first described anti-N-methyl-D-aspartate receptor encephalitis as a paraneoplastic manifestation of ovarian teratoma [1]
We present here a novel case of anti-NMDA receptor encephalitis where the patient experienced an episode of ictal torsades de pointes with cardiac arrest
In one study conducted in the United Kingdom, anti-NMDA receptor antibodies were found in 1% of the patients with encephalitis admitted to intensive care units [5]
Summary
In 2007, Dalmau et al first described anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis as a paraneoplastic manifestation of ovarian teratoma [1]. We present here a novel case of anti-NMDA receptor encephalitis where the patient experienced an episode of ictal torsades de pointes with cardiac arrest. During the CT abdomen study, the patient unusually developed a tonic-clonic seizure with subsequent cardiac arrest Her initial cardiac rhythm showed polymorphic ventricular tachycardia, consistent with torsades de pointes (Figure 3). Based on the presence of clinical features consistent with the probable criteria, CT findings showing an adnexal mass, most likely a teratoma, and after the exclusion of other possible etiologies, a diagnosis of anti-NMDA receptor encephalitis was established. She underwent one plasmapheresis session concurrently with intravenous immunoglobulin (IVIG) therapy.
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