An emerging problem in clinical practice: how to approach acute psychosis

  • Sofia Markoula | smarkoula@grads.uoi.gr Department of Neurology, University of Ioannina; Neurology Clinic, General Hospital of Ioannina, Ioannina, Greece.
  • Dimitrios Chatzistefanidis Department of Neurology, University of Ioannina, Ioannina, Greece.
  • Spyridon Konitsiotis Department of Neurology, University of Ioannina, Ioannina, Greece.
  • Athanassios P. Kyritsis Department of Neurology, University of Ioannina, Ioannina, Greece.

Abstract

Limbic encephalitis (LE) is rare, presents with memory impairment, seizures and behavioral disorder. We present a 44-year-old female with an agitation-depressive disorder associated with delusions and hallucinations, admitted to our hospital with the diagnosis of psychosis. A computed tomography (CT) scan of the brain and lumbar puncture on admission were normal. Because of clinical deterioration and addition of seizures in the clinical picture, further workup with serum and repeat cerebrospinal fluid studies, magnetic resonance imaging (MRI), and electroencephalogram disclosed a lesion in the left medial temporal lobe consistent with LE. The patient was treated symptomatically with antidepressive, antipsychotic and anticonvulsant drugs. Aggressive diagnostic tests for the presence of an occult cancer were negative. An 8-year follow up has not revealed a tumor to support a paraneoplasmatic origin of LE. This case, initially diagnosed and treated as psychosis, is a case of non-paraneoplasmatic, non-infective LE, probably caused by an autoimmune mechanism.

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Published
2011-12-30
Section
Case Reports
Keywords:
encephalitis, psychosis, Limbic system.
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How to Cite
Markoula, S., Chatzistefanidis, D., Konitsiotis, S., & Kyritsis, A. (2011). An emerging problem in clinical practice: how to approach acute psychosis. Clinics and Practice, 2(1), e7. https://doi.org/10.4081/cp.2012.e7