Anti-NMDAR limbic encephalitis- a clinical curiosity

BACKGROUND Neurological paraneoplastic syndromes are rarely the first manifestation of an underlying cancer. A high index of suspicion is thus needed to diagnose such conditions. Paraneoplastic limbic encephalitis is one such entity which is well described in association with small cell lung cancers, testicular germ cell tumors, breast cancers and ovarian tumors. This article describes the entity being associated with an ovarian tumor. CASE A 36-year-old female presented with abnormal behaviour, mood swings and delusions. She was evaluated for her psychiatric symptoms and found to have an underlying ovarian tumor. Anti-NMDA receptor titers were strongly positive. She underwent oophorectomy, and post-operatively there was a significant improvement in her psychiatric symptoms. CONCLUSIONS Ovarian tumors like teratomas are implicated in the pathogenesis of paraneoplastic limbic encephalitis. An underlying ovarian tumor must be evaluated in all young females presenting with sudden onset of psychiatric symptoms.