A 21-year-old woman develops acute behavioural change, memory disturbance, seizures, and orofacial dyskinesias over two weeks. CSF shows lymphocytic pleocytosis. Ultrasound reveals a 7 cm right ovarian cyst with fat and calcification. What is the most appropriate definitive management?

• A Serial imaging of the cyst with neurological follow-up
• B Long-term antipsychotic and antiepileptic therapy alone
• C Total abdominal hysterectomy with bilateral salpingo-oophorectomy
• D Removal of the ovarian cyst with immunotherapy ✓

Explanation

The presentation is anti-NMDA receptor encephalitis caused by antibodies against neuronal NMDA receptors expressed by mature neural tissue within a mature cystic teratoma. Definitive treatment is excision of the teratoma combined with immunotherapy, which produces the best neurological outcomes. Antipsychotics control symptoms only, observation risks progression, and hysterectomy with castration is excessive because unilateral cystectomy suffices.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.