Just after going to work in the morning, an anxious middle-aged woman came and led a young girl to the consulting room. She said that her daughter could not sleep well in the past week. She would have hallucinations at night. She would often hear the sound of running water, and there would even be people trying to harm her. When I got up this morning, I lost consciousness again, my limbs twitched, and I was accompanied by urinary incontinence. After about 1-2 minutes, I regained consciousness.
The girl said that she had been under great pressure at work in the past week, and her boss bullied her, which made her feel like she was going to collapse.
After listening to the mother and daughter, I roughly understood the girl’s symptoms: loss of consciousness, twitching of limbs, urinary incontinence, hallucinations, insomnia, and depression. There were no obvious abnormalities on neurological examination. Although the girl's speech was clear at this moment, she had already suffered from severe symptoms of loss of consciousness and twitching of her limbs. She could not be let go easily, and a more serious situation might occur.
I said to them: "In your case, it is best to be hospitalized for further examination."
Her mother was very active and cooperative, but the girl was not very happy. But in the end I chose to be hospitalized for observation. We performed a brain MRI on her and found abnormal signal shadows in the left temporal lobe. Considering the possibility of encephalitis, a lumbar puncture was performed, but the cerebrospinal fluid routine and biochemistry were normal.
Unexpectedly, on the third day after being admitted to the hospital, the girl began to talk nonsense, and soon fell into a coma. Her mother was very excited and could not accept this result at all.
The girl has symptoms of encephalitis, and there is no evidence of infectious diseases in the cerebrospinal fluid. In addition, she is a young girl. Autoimmune encephalitis must first be considered.
There are research reports: Autoimmune encephalitis in young women is often accompanied by ovarian tumors and thymus tumors. We performed gynecological imaging examinations, chest imaging examinations, and cerebrospinal fluid antibody testing for her. The result was that she had teratomas on her ovaries and her cerebrospinal fluid was positive for anti-NMDA-R antibodies.
So she has autoimmune encephalitis and teratoma.
Later, after her condition improved, she underwent ovarian removal surgery and sent for pathological examination. After the ovary was cut open, there were teeth and hair inside.
teratoma
How does teratoma occur?
Teratomas are ovarian germ cell tumors that are benign in most cases. Because germ cells have the potential to differentiate in all directions, they often differentiate into skin, sebaceous glands, hair, teeth, and sometimes the tissue structures of the thyroid and pancreas can be found in the ovary.
Imaging: Teratomas usually have no symptoms, but when they grow to a particularly large size and the fallopian tubes torsion, acute abdominal pain may occur. Teratomas can generally be found through color Doppler ultrasound examination, abdominal CT examination, or abdominal MRI examination.
Pathology: Most teratomas are benign, but a few may worsen. Therefore, after surgical resection, the removed tumor must be sent to the pathology department for examination. Gross examination often shows that the mass is cystic, and hair, sebum, teeth, and dermatomes can be found inside.
Using a microscope, you can see skin tissue, hair follicles, and sebaceous gland tissue. Conditions such as the thyroid gland and pancreas can sometimes be seen.
Teratoma CT image
Autoimmune encephalitis
How did teratoma cause the girl to become comatose? It may be that tumor cells produce some special antibodies that can specifically damage nerve cells. Antibodies are like bullets that travel throughout the body through the bloodstream. Because these antibodies particularly like nerve cells, they can cause nerve cell damage. So the girl suffered symptoms such as coma, convulsions, and hallucinations.
This girl recovered well after immunological treatment and surgery.
Ultrasound image of teratoma
Summary: Through this case, I feel that the human body is really complex and ever-changing. What has been studied so far is only the tip of the iceberg, so we must be in awe.
This patient was easily dismissed during the first visit, which is dangerous and can be difficult to deal with if he becomes comatose at home or at work.
It is sometimes difficult to distinguish between autoimmune encephalitis and viral encephalitis, and may be treated as viral encephalitis, resulting in delayed treatment.
This article is original, everyone is welcome to pay attention. I will continue to share my experience in medical work, learn a little medical knowledge every day, understand my own body, and be an angel who protects myself.
