Anti-NMDA receptor encephalitis associated with ovarian tumor: the gynecologist point of view

Arch Gynecol Obstet. 2020 Aug;302(2):315-320. doi: 10.1007/s00404-020-05645-9. Epub 2020 Jun 17.


Background: Anti-NMDA receptor antibody (anti-NMDAr) encephalitis, although still a rare condition, is well known to neurologists as it is the leading cause of non-infectious acute encephalitis in young women. However, this is less well known to gynecologists, who may have a decisive role in etiological management. Indeed, in 30-60% of cases in women of childbearing age, it is associated with the presence of an ovarian teratoma, whose removal is crucial in the resolution of symptomatology.

Objectives: Primary objective of our work was to present a review in a very schematic and practical way for gynecologists, about the data on anti-NMDAr encephalitis in terms of epidemiology, clinical symptomatology, treatment and prognosis. The second objective was to propose a decision tree for gynecologists to guide them, in collaboration with neurologists and anesthesiologists, after the diagnosis of NMDAr encephalitis associated with an ovarian mass.

Method: We conducted an exhaustive review of existing data using PubMed and The Cochrane Library. Then, we illustrated this topic by presenting two typical cases from our experience.

Results: Anti-NMDA antibody encephalitis association with an ovarian teratoma is common, especially in women of reproductive age. Complementary examinations in search of an ovarian teratoma must therefore be systematic to envisage a possible surgical excision that may improve patient prognosis.

Conclusion: Anti-NMDA antibody encephalitis should not be ignored by gynecologists whose role in management is central.

Keywords: Anti-NMDA receptor encephalitis; Gynecologic oncology; Gynecologic surgery; Immature ovarian teratoma; Ovarian teratoma.

Publication types

  • Review

MeSH terms

  • Adult
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / diagnosis
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / epidemiology
  • Anti-N-Methyl-D-Aspartate Receptor Encephalitis* / therapy
  • Antibodies / cerebrospinal fluid*
  • Female
  • Humans
  • Ovarian Neoplasms / complications*
  • Ovarian Neoplasms / pathology
  • Ovarian Neoplasms / surgery
  • Physical Examination
  • Prognosis
  • Receptors, N-Methyl-D-Aspartate / immunology*
  • Reproduction
  • Teratoma / complications*
  • Teratoma / pathology
  • Teratoma / surgery
  • Young Adult


  • Antibodies
  • Receptors, N-Methyl-D-Aspartate

Supplementary concepts

  • Teratoma, Ovarian