1. 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

2. 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

3. Chest radiography(2016/05/28)

4. Chest CT (2016/06/01)

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

6. Mature Cystic Teratoma with Paraneoplastic Anti-NMDA Rc Encephalitis

7. 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

8. 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) , 2014, Journal of Thoracic Oncology, 7(1), 2012