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Autoimmune encephalitis anti-NMDAR — SCE Neurology MCQ

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HardCognitive NeurologyAutoimmune encephalitis anti-NMDARSCE Neurology

A 24-year-old woman is ventilated with anti-NMDA-receptor encephalitis. CSF antibodies are positive and pelvic ultrasound is equivocal for a 3-cm ovarian lesion. Alongside first-line immunotherapy, which tumour-directed plan is most appropriate?

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Correct answer: E — Obtain pelvic MRI and resect the lesion if it confirms teratoma

Ovarian teratoma is common in adult women with anti-NMDA-receptor encephalitis, and tumour removal is a key component of treatment rather than a late surveillance exercise. Because ultrasonography is equivocal, definitive pelvic imaging and gynaecological input are needed. If a teratoma is confirmed, removal should proceed alongside immunotherapy; waiting for neurological recovery can delay a treatment that improves the chance of response. Tumour markers cannot exclude a small teratoma. Continued or repeat screening is reasonable when initial investigations are negative or equivocal, but it should not be postponed for months in a high-risk patient.

Reference: Autoimmune encephalitis: clinical spectrum and management: https://pn.bmj.com/content/21/5/412