Rinsho Shinkeigaku (Clinical Neurology)

Brief Clinical Note

Glioblastoma with ovarian teratoma having N-methyl-D-aspartate receptor (NMDAR) antibody in CSF--A case report

Hiroki Fujii, M.D.1)4), Satoshi Kubo, M.D.1)4), Taijun Yunoki, M.D.1)5), Kouta Sato, M.D.1)5), Kazuhiro Takamatsu, M.D.1), Keiko Tanaka, M.D. Ph.D.2), Yukitoshi Takahashi, M.D., Ph.D.3) and Masaru Kuriyama, M.D., Ph.D.1)

1)Department of Neurology, Ota Memorial Hospital.
2)Department of Neurology, Kanazawa Medical University
3)National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders
4)Present address: Department of Clinical Neuroscience and Therapeutics, Hiroshima University
5)Present address: Department of Neurology and Neuroscience, Okayama University

A 54-year-old woman presented with complex partial seizure with impaired consciousness. Brain MRI revealed a high intensity lesion on T2-weighted and FLAIR images in the left temporal lobe, indicating limbic encephalitis. CT and MRI of the pelvis showed right ovarian teratoma. The cerebrospinal fluid (CSF) were positive for antibodies against the GluRε2, GluRδ2, and antibodies against NR1 + NR2B heteromers. On the basis of these data, anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis associated with ovarian teratoma was suspected, and the right ovariectomy was performed. Six months after onset, brain biopsy from the right temporal lobe led to a diagnosed of glioblastoma. This is the first glioblastoma case with ovarian teratoma having autoantibodies against GluR and NR1 + NR2B heteromers in CSF. We suggest that patients with NMDAR antibodies should be carefully diagnosed with anti-NMDAR encephalitis.
Full Text of this Article in Japanese PDF (8744K)

(CLINICA NEUROL, 53: 712－715, 2013)
key words: ovarian teratoma, anti-N-methyl-D-aspartate receptor antibody, glioblastoma, limbic encephalitis

(Received: 7-Sep-12)