During the CT abdomen study, the patient unusually developed a tonic-clonic seizure with subsequent cardiac arrest

During the CT abdomen study, the patient unusually developed a tonic-clonic seizure with subsequent cardiac arrest. [2-5]. The clinical presentation is related to psychiatric complaints and movement disorders?[6]. Although this disease is commonly encountered in young women with ovarian teratoma, reports involving children and men with no tumors are also available?[7-10]. Ictal arrhythmias, most likely originating from the sinus node, are well-established events in patients with autoimmune encephalitis. Prior anecdotal clinical evidence also suggests an increased propensity of developing cardiac arrhythmia secondary to anti-NMDA receptor encephalitis [11]. However,?torsades de pointes with cardiac arrest is an extremely rare occurrence in these patients. We present here a novel case of anti-NMDA receptor encephalitis where the patient experienced an episode of GSK2190915 ictal torsades de pointes with cardiac arrest. Cardiac pathology was successfully managed as a part of the central nervous system?(CNS) pathology. Aggressive immunomodulation and surgical removal of underlying ovarian teratoma resulted in a cure for both encephalitis and cardiac instability. Therefore, we speculate?that prompt treatment of encephalitis may resolve?the dysrhythmias without GSK2190915 the need for permanent pacing. Additionally, we review the pertinent medical literature for cardiac complications in patients with anti-NMDA receptor encephalitis. Case presentation A 34-year-old female with a history of mild depression was referred to our hospital from a psychiatric facility for medical evaluation of acute-onset bizarre behavior and intermittent unresponsiveness. The patient was occasionally redirectable and answered questions but she often appeared?withdrawn, hallucinating (auditory), internally stimulated, and exhibited echolalia. Per collateral information, she was under extreme stress at work. She had experienced two similar?self-limiting episodes in the past year. Her home medications included escitalopram, and she did not use dietary supplements. She denied fever, nausea, vomiting, and diarrhea. Her family history was negative for psychiatric disorders. Upon initial evaluation, she was completely withdrawn, tachycardic (130 beats/minute), hypertensive (174/115 mmHg), and afebrile. She had occasional non-rhythmic face twitching, ICAM3 hyperreflexia, and down-going toes. Laboratory studies were significant for hypokalaemia (3.1 mmol/L), increased anion gap (18 mEq/L), and hyperglycemia (blood sugar fasting: 123 mg/dL). Her liver function testing showed alanine aminotransferase (ALT) GSK2190915 194 IU/L, aspartate aminotransferase (AST) 327 IU/L, total bilirubin 2.2 mg/dL, and direct bilirubin 0.9 mg/dL. The thyroid-stimulating hormone level was 2.58 mIU/mL. Her serum magnesium level was 0.9 mmol/L. Blood analysis for alcohol and acetaminophen was negative. The urine pregnancy test was negative. Urine drug screening and analysis detected benzodiazepines and ketones, respectively. A computed tomography (CT) scan of the head was negative for gross acute intracranial hemorrhage, mass effect, or hydrocephalus. GSK2190915 CT abdomen and pelvis without contrast revealed a 9 x 8-cm complex mass in the right adnexa, which mimicked a teratoma (Figure?1). Open in a separate window Figure 1 Computed tomography scan of the abdomen and pelvis showing a 9.2 x 6.5 x 7.8-cm mass (arrow) in the right adnexa, likely arising from the right ovary containing fat, fluid, and calcific densities (axial view). The coronal view of the CT scan of the abdomen and pelvis showed the longest diameter of the teratoma to be 77.91 mm?(Figure 2). Open in a separate window Figure 2 Computed tomography scan of the abdomen and pelvis showing the teratoma (arrow; coronal view). Findings of volume overload with ascites, mesenteric edema, and anasarca were also noted. During the CT abdomen study, the patient unusually developed a tonic-clonic seizure.