Biography
Biography: UKD Ajith Goonetilleke
Abstract
A 31-year old pregnant female was admitted with generalized tonic-clonic seizures. There was a history of a 3-day prodrome of confusion, auditory and visual hallucinations, and behavioral disturbances. She was initially treated with anticonvulsants and intravenous (IV) acyclovir. The patient’s behaviour worsened, and she developed extrapyramidal features, myoclonic jerks affecting mouth and lips, orolingual and limb dyskinesias, and episodic oculo-gyric crises. Ultrasound (transvaginal and abdominal) scans, CT scans of chest, abdomen and pelvis, and MRI brain scans were normal. A CSF examination was normal. Blood and CSF samples were positive for anti- N-methyl D-aspartate receptor (NMDA-R) antibodies. Initial treatment consisted of IV immunoglobulins, IV followed by oral steroids, and plasma exchanges. A first trimester miscarriage occurred. As she did not improve she received 4 courses of IV Rituximab, followed by monthly pulses of IV Cyclophosphamide. The patient improved, and by the time of her discharge (6 months after initial admission) she was independently ambulant, orientated in time, place and person, and able to communicate in 3 different languages. There were some residual short-term memory deficits which subsequently improved, and she returned to full-time employment as a chemial engineer. As she remained positive for anti-NMDA-R antibodies the pelvic investigations were repeated 6 months later. Ultrasound and MRI scans of the pelvis showed a right ovarian cyst. A laparoscopic cystectomy was peformed, and the 3 x 2 x 1.5 cm cyst that was removed had the histological features of an ovarian teratoma. She was negative for anti-NMDA-R antibodies 9 months later