RARE OVARIAN TERATOMA PRESENTATION OF LIMBIC ENCEPHALOPATHY: A CASE STUDY

UPP 113

Introduction. In female patients there is now the emergence of a previously under diagnosed disorder with severe neurological complications of limbic encephalopathy (LE) resulting from ovarian teratomas. The abnormal presentation can lead to a primary diagnosis of a behavior medicine disorder. Clinicians need to be aware of this autoimmune disease. Case presentation. A 15-year-old Caucasian female was transported to the emergency department by ambulance after an acute loss of consciousness, seizure activity, and severe temporal lobe headaches. Associated symptoms included episodes of altered awareness, depersonalization, confusion and memory loss. Diagnosis focused on LE and paraneoplastic syndrome. Surgical consultation ordered an abdominal ultrasound because of a previous ovarian teratoma removed by laparoscopy two years prior. A diagnosis of a recurrent ovarian teratoma was made. Deviation From the Expected. Despite high morbidity and mortality rates associated with limbic encephalopathy (LE) aggressive surgical management resulted in symptoms dramatically improved after the excision of the right ovary. Discussion. Labs were negative for both anti N-methyl-D-asparate (NMDA) receptor antibody and paraneoplastic syndrome. Pathology obtained imunohistological stains demonstrated positive mature neuroepithelium tissue consistent with a ovarian benign teratoma. A review of the literature revealed ovarian teratoma LE with neurological and psychological symptoms consistent with this case. Conclusion. The surgical treatment of this condition was laparoscopy with ovarian teratoma excision that resulted in immediate improvement of the patient's condition. Clinicians in an acute setting must maintain a high index of suspicion for ovarian teratoma LE in female patients that present with neurological and bizarre psychological symptoms. Grants. none