C.C. Psychosis, Mental change Abnormal aggressive behavior

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Presentation transcript:

C.C. Psychosis, Mental change Abnormal aggressive behavior 10월 흉부 영상 월례 집담회 F/25 Case 2 C.C. Psychosis, Mental change Abnormal aggressive behavior 아주대학교 병원 김은영

EEG and Spinal Tap (2016.05.28) Color Color less Appearance Clear S.G 1.005 RBC count 0 / ul WBC count 130 / ul Lymphocyte 95% Monocyte 5% Protein 27.2 mg /dl Glucose 58 mg/dl Extreme delta blush Probably caused by systemic derangement or inflammatory process

Chest radiography(2016/05/28)

Chest CT (2016/06/01)

Anterior mediastinal mass excision (VATS)  Mature cystic teratoma Auto antibody Screening (2016/06/02 sampling)  NMDAR autoimmune antibody: Positive

Mature Cystic Teratoma with Paraneoplastic Anti-NMDA Rc Encephalitis

Anti NMDA Receptor Encephalitis Autoimmune antibodies against NMDA receptors Results in marked reduction of surface NMDA receptor in post-synaptic dendrites Epidemiology Most common in young female patients Median age: 23 yrs Female:Male – 4:1 Clinical presentation Prominent psychiatric symptoms Progress from psychosis to movement disorder and coma BJPsych Bulletin,39:19-23,2015

Anti NMDA Receptor Encephalitis related to mediastinal teratoma Up to 50% of patients have tumors, mainly ovarian teratoma Extragonadal teratomas may occur in the head, neck, thyroid, and mediastinum Diagnosis Identification of anti NMDA antibody in serum & CSF Imaging findings of teratoma Neural tissue triggers an immune response  over production of anti NMDAR antibodies Combination of tumor removal and immunotherapy Early removal of tumor was associated with better outcomes and fewer relapse Journal of Child Neurology, 29(5) 688-690, 2014, Journal of Thoracic Oncology, 7(1), 2012