The 20-year-old girl fell asleep for a month after talking gibberish and woke up on the third day after removing the ovarian teratoma

The Paper's reporter Chen Sisi correspondent Zhu Fan zhou bangyan

At the beginning of 2021, parents found in their daily communication that their 20-year-old daughter Qianqian (pseudonym) was like a "demon", sometimes talking gibberish, sometimes repeating words, and sometimes mentally acting abnormally excited.

One day in June, Qianqian felt a headache, nausea and vomiting, at first everyone thought it was a cold, and no one paid attention to it. Two days later, her face began to twitch and her mouth corners were crooked, and she was immediately sent by her parents to the neurology department of a top three hospital in Shanghai.

Qianqian fell asleep in the hospital ICU for a month, and the doctors went all out to help her recover. However, blood draws, whole-body CT, cerebrospinal fluid, and the tests that can be done have been done, but the cause has still not been found. The doctor sent an invitation to Shanghai Ruijin Hospital for consultation.

Dr. Zhong Huiping of Ruijin Hospital said that when she first saw Qianqian, she felt like a lifeless plant, lying upright on the hospital bed, staring at the ceiling with her eyes stunned, and did not react at all to what was happening around her. Her limbs were bound by restraint bands to prevent herself from hurting herself during manic attacks.

Years of medical experience told her that Qianqian's illness was not simple. "As an obstetrician-gynecologist, you first need to rule out diseases in this discipline during consultation. I tightened a string at that time, some gynecological tumors, especially relatively small tumors, CT scan is easy to miss, like a transfiguration master, difficult to distinguish. At that time, I suggested that I do a pelvic enhancement CT to see the girl's bilateral ovaries. ”

Sure enough, the pelvic enhancement CT showed that Qianqian had a 2 cm diameter placeholder on the left ovary, considering the possibility of teratoma, while the cerebrospinal fluid showed that the anti-NMDA receptor antibody was positive. It turned out that Qianqian was suffering from anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis complicated with ovarian teratoma, since the first reported case in the world in 2007, so far there have been no more than 100 cases reported worldwide, and anti-NMDA encephalitis patients caused by teratomas are even more rare.

"Finding the cause of the disease is really reassuring. Diagnosing such rare diseases is very difficult, and we have seen 3 similar patients before. Zhong Huiping said.

Unexpectedly, just after finding out the cause, Qianqian's condition took a sharp turn for the worse, she was completely unconscious, and she needed to rely on a ventilator to maintain basic vital signs.

He is in critical condition and in urgent need of surgery. Ruijin Hospital revealed that because Qianqian's hospital does not have an obstetrics and gynecology department, it issued a consultation application to the medical office of Ruijin Hospital, inviting Dr. Zhong Huiping and Yang Chenmin of the Obstetrics and Gynecology Department of Ruijin Hospital to rush to the hospital to perform "general anesthesia laparoscopic ovarian teratoma removal emergency surgery" for Qianqian.

The operation took only 20 minutes and went very smoothly. On the third day after the operation, Qianqian woke up. Her father found that Qianqian, who had been lively and clever in the past, had finally returned!

Zhong Huiping said that teratoma is one of the common ovarian tumors in gynecology, which can occur at any age, mostly young women, generally no obvious symptoms, mostly found during physical examination. Anti-NMDAR encephalitis is a rare disease, the first report was in 2007, mainly manifested as severe mental symptoms, behavioral abnormalities, acute memory loss, convulsive attacks, movement disorders, insufficient ventilation and autonomic dysfunction, so far, more than 100 cases of anti-NMDAR encephalitis have been reported abroad.

The anti-NMDAR encephalitis with ovarian teratoma is more rare, when the tissue of the ovarian teratoma differentiates into the neural tissue, the neural tissue may induce antibodies as antigenic substances, and the antibody attacks the brain tissue to cause autoimmune encephalitis (anti-NMDAR encephalitis), which will cause mental abnormalities, epilepsy, coma and other mental symptoms.

Zhong Huiping reminded that if the clinical cold sudden mental symptoms with seizures, reduced level of consciousness and movement disorders of young female patients, should take this possibility into account, as early as possible removal of ovarian lesions can help save lives and reduce damage to the nervous system.

Editor-in-Charge: Gao Wen