Table 1.
Clinical Features
| Case No. | Sex/Age(yr) | Teratoma: Histology, Side, Size | Time to Tumor Diagnosis | Prodrome | Presenting Symptoms | Other Symptoms and Findings during the Course of the Disorder |
|---|---|---|---|---|---|---|
| 1 | F/30 | Immature, right ovary, 10cm | 2 months | Headache, hyperthermia | STMD, decreased level of consciousness, “epilepsia partialis continua” for 2 weeks; sedation, MV, PEG | Restlessness, involuntary movements, hyperthermia |
| 2 | F/35 | Mature, left ovary, 3.5cm | 4 months (autopsy) | Headache, nausea, no fever; received acetaminophen | STMD, generalized tonic-clonic seizure followed by refractory status epilepticus; sedation, MV, and PEG | Partial motor seizures in left lower extremity; dystonic movements; hyperthermia |
| 3 | F/25 | Mature, left ovary, 6cm | 6 weeks | Hyperthermia | STMD, panic attacks, confusion, hallucinations(admitted to psychiatric center); subsequently, partial complex seizures, TPN, PEG | Episodes of staring; minimally reactive to stimuli; catatonic-like episodes; autonomic instability: tachycardia, high blood pressure |
| 4 | F/17 | Immature, left ovary, 7cm | 4 weeks | Hyperthermia | Bizarre behavior, disorganized thinking, restless, wandering aimlessly, hallucinations, catatonic-like episodes (2 admissions in psychiatric centers); subsequently, status epilepticus; sedation, MV | Incoherent speech; episodes of staring, catatonia, oculogyric crisis, choreoathetoid movements; autonomic instability: hyperthermia; mydriasis during episodes of restlessness and agitation |
| 5 | F/32 | Mature, right ovary, 6cm | 2 months | NA | Acute development of personality change, abnormal behavior, confused, agitated, wandering off(admitted to psychiatry); generalized tonic-clonic seizures, partial motor seizures, severe general encephalopathy, PEG | Unable to speak and follow commands for 2 months; episodes of “facial twitches” |
| 6 | F/24 | Mature, right ovary, 1.5cm | 3 months (autopsy) | Headache, hyperthermia, nausea, vomiting, diarrhea | Paranoid thoughts, auditory hallucinations, agitation(admitted to psychiatry); subsequently, generalized seizure; sedation, MV, PEG; remained with decreased level of consciousness and ventilator dependent | Myoclonic and dyskinetic movements in arms and face; autonomic instability: alternating hypothermia/hyperthermia, hypotension/hypertension; during awake periods, tachypnea; during sleep periods, problem triggering ventilator |
| Previously reported patients | ||||||
| 76 | F/19 | Immature, right ovary, 22cm | 4 months | Headache, hyperthermia | Acute personality change, aggressive behavior (seen at a psychiatric center); progressive confusion, decreased level of consciousness; general and partial seizures, refractory status epilepticus; sedation, MV, PEG | Episodes of “chewing, grimacing”; myoclonic and ballistic movements with limbs; rhythmic contractions of abdominal wall; dystonic movements of the trunk and limbs; opisthotonos-like posture; insomnia/hypersomnia |
| 84 | F/26 | Left ovarian dermoid cyst by CT,a1.6cm | 3 weeks | Anorexia and insomnia(3 weeks) | Psychiatric syndrome, generalized seizures, MV, PEG | Incomprehensible speech, decreased of level of consciousness, STMD, hyperthermia |
| 94 | F/40 | Mature, left ovary, 6.0cm | 3 weeks | NA | Secondary generalized seizures, psychiatric syndrome, MV, PEG | Decreased level of con sciousness, STMD |
| 104,8 | F/14 | Immature, left ovary, 1.9cm | 2 months | Hyperthermia, headache, rhinorrhea | Psychiatric syndrome (hallucinations, extreme panic), generalized seizures, MV, PEG | Incomprehensible speech, choreoathetotic movements, hypersomnia, hyperthermia, autonomic instability |
| 114,7 | F/28 | 1st episode: mature, right ovary, 14cm; 2nd episode: “benign,” left, 2cm; 3rd episode: “benign,” left, 1.7cm | 1 month after tumor | Cough, no fever; received antibiotics | 1st episode: psychiatric syndrome (delusional thinking, personality change), auditory hallucinations, STMD, dysphagia, horizontal nystagmus, vertical gaze paresis, MV 2nd episode: dysarthria 3rd episode: diplopia, facial numbness, dysphagia, ataxia | 1st episode: hypersomnia, comatose, flaccid paraplegia |
| 125 | F/44 | Mature, mediastinum, 6.5cm | 3 weeks | Hyperthermia, headache | Admission to psychiatry for acute agitation, personality change, memory loss, generalized tonic-clonic seizures, MV for PE, PEG | Word finding difficulty, mild right hemiparesis, episodes of diaphoresis, hypersomnia, headache |
STMD = short-term memory deficits; MV = mechanical ventilation; PEG = percutaneous endoscopic gastrostomy; PE = pulmonary embolism; TPN = total parenteral nutrition; CT = computed tomography; NA = not available.