Organic Brain Lesions Research Articles

Capgras Syndrome with Pregnant Woman: A Case Report and Literature Review

Background: Capgras syndrome is one of the delusional misidentification syndromes characterized by the delusional belief by the patient that the close person is replaced by an imposter who looks physically the same. Capgras syndrome was initially considered a purely psychotic disorder, but recently, Capgras syndrome understands as a neurological disorder, in which the delusion primarily results from organic brain lesions or degeneration. The case report aims to review previous literature on topic and present a case of pregnant woman experiencing Capgras delusion under full consciousness and whose expediencies are not linked to any psychiatric or neurological illness. Case presentation: A 29 year old, pregnant woman was brought for psychiatric consultation by her family with chief complaints of belief that her husband had been replaced by identical impostor, associated with irritability, anger and hostility since 4 months and aggravated in the last month. This pregnant woman showing absence of emotional response, no familiarity toward her husband and delusion that her husband replaced by imposter. Conclusion: Capgras syndrome is not necessarily pathological and can occur in a healthy population. Capgras syndrome may happen spontaneously under full consciousness in the healthy subjects; like in neurological and psychiatric patients. In this case report the phenomenological aspects of Capgras syndrome may similar in the content of the delusion to other studies were carried out with psychiatric or neurological patients, but no evidence of depersonalization, physical violence or aggression.

History of the creation and activity of the Functional Neurology Research Unit over 30 years

Background: The Functional Neurology Research Unit (FNRU) was created in 1992 at the State University of Medicine and Pharmacy of the Republic of Moldova. The activity of the scientific unit was essentially based on the concept of Functional Neurology, which was published in an article in the prestigious Italian journal Functional Neurology (1998) and continues to be further developed by Professors I. Moldovanu and V. Vovc. Conclusions: Physiological aspects in the researches carried out by collaborators of the FNRU concerned research of breathing pattern, autonomic parameters of suprasegmental and segmental level (research of heart rate variability, segmental vegetative samples, etc.), reactivity of cerebral vessels to modeled hypocapnia, trigeminal, somesthetic, visual, auditory evoked potentials in patients with chronic headache, etc. To conclude, the scientific objectives of the research carried out by the collaborators of the Functional Neurology Research Unit during 30 years of activity – the development of the problem of identifying and using the huge, so far still insufficiently researched possibilities of the “reserves” of the human brain for therapeutic purposes (treatment of chronic pain, movement disorders as a result of organic brain lesions, autonomic disorders, etc.) in the context of a new, modern and advanced understanding of the relationship and interaction of the human brain, psyche and body within a social background which is the essence of the functional neurology.

To study clinical profile and correlation of EEG and CT findings in diagnosis of focal seizures in children at medical institution in mid – Karnataka region

Focal-onset seizures account for approximately 40% of seizures in children. Focal seizures are most commonly associated with underlying brain pathology in extreme age groups. Clinical correlation and localizing the site of the lesion play an important role in the early diagnosis and proper management of focal seizures in children. Objectives: To study the clinical profile and correlation of EEG and CT findings in children admitted to the paediatric ward of Medical College.A prospective study on the correlation of focal seizures, CT brain, and EEG studies was carried out in children in the age group of 1 month–14 years admitted to the Department of Pediatrics at Medical College & Hospital, Karnataka. Among the (n=50) study subjects, the majority of the children with focal seizures were in the age group of 6–10 years, with a slight male preponderance.(n=22) (44% of the children) presented with focal-aware seizures. The most common brain lesions detected were calcified disc lesions and cysticercosis ring lesions (52%).45% of children with focal seizures had epileptiform discharges. We also observed that complementary to CT brain scans in correlating with the clinical history. It was noted that44% of children with focal seizures had normal CT brain scans and normal EEG studies. A good clinical history is crucial in the diagnosis of focal seizures. Most focal seizures are associated with underlying organic brain lesions. A CT brain scan plays an important role in the detection of brain lesions in children with focal seizures. The EEG study complements history and CT scan of the brain in defining and correlating the lesions precisely.

Possibilities of combined use of peptides in the treatment of post-stroke asthenia

Among the various syndromes in the post-stroke period, asthenic disorder plays an important role, the presence of which is associated with unfavourable course of the disease. Post-stroke fatigue is, on the one hand, the result of organic brain lesions and, on the other hand, a person's emotional reaction to the clinical manifestations of stroke and its consequences. Affective and cognitive disorders are common comorbidities of fatigue after stroke. To correct asthenic manifestations, a holistic approach with pharmacological, physical, and psychological treatments is used. The main components in the pathogenesis of fatigue are hypoxia and energy imbalance, so it seems reasonable to include in the complex therapy of post-stroke fatigue the drug Cytochrome C, which is a key peptide of the mitochondrial respiratory chain. Considering the frequent combination with cognitive disorders of different modality, the use of bovine cerebral cortex polypeptides in patients with post-stroke fatigue is pathogenetically reasonable. Inclusion of drugs with a complex mechanism of action on hypoxia, oxidative stress, energy deficiency, and neuroplasticity processes in the therapeutic algorithm may increase the effectiveness of treatment.

Interrelationship of Psychotherapy, Psychocorrection and Psychoconsultation

Modern neurorehabilitation is focused primarily on the restoration of speech and cognitive mental processes, considering the rehabilitation of the individual as a task of psychotherapy. The article shows that a gentle attitude, a change in "body image" and neurotic experiences, characteristic of most patients with organic brain lesions, significantly affect the effectiveness of neuropsychological rehabilitation. Neurorehabilitation focuses on the restoration of speech and cognitive processes, considering the rehabilitation of the individual as an object of psychotherapy. On the basis of clinical cases, it has been shown that the weakened attitude, body image changes, and neurotic experiences characteristic of most patients with idiophrenic disease affect the effectiveness of neuropsychological rehabilitation. The article examines the theoretical and methodological principles and defines the main concepts of the topic. The relevance of the article is determined by the new innovative social needs in solving problems of a psychological nature, taking into account the neurological features of human thinking. Scientific intelligence in the field of neurorehabilitation provides grounds for determining the most effective methods of psychocorrection. The purpose of the study is to determine the relationship between psychotherapy, psychocorrection and psycho-counseling based on neurorehabilitation. After studying the data, it was determined that the ischemic attack of the brain was unspecified, it was suggested that the observed neurological symptoms (disorders of speech, movements, emotional sphere) are related to residual (residual) symptoms after a transient ischemic attack, which requires a detailed study.

Auditory Brainstem Response Testing in Children with Speech and Language Pathology: A Non-Randomized Observational Study

Introduction: The aim of this study was to compare auditory brainstem response (ABR) findings of normal-hearing preschool children with different types of speech and language pathology. Methods: This retrospective, non-randomized, cohort study was conducted at a tertiary speech and hearing rehabilitation institution according to STROBE guidelines. The study enrolled 123 preschool children diagnosed with speech language pathology and normal hearing. The participants included children with developmental language disorder, autism spectrum disorder, isolated articulation pathology, organic brain lesions, cognitive delay, and a group of very young children with clinically significant speech development delay. All patients underwent standard ABR procedures. Results: The latencies were the longest in the group of children with organic lesion, followed by the group of children with autism spectrum disorder, then the group with developmental language disorder, and the young children group. In the group of children with articulation pathology and the cognitive delay group, the latencies were the shortest. Conclusion: This study showed a connection between several groups of children with language pathology that includes comprehension problems and prolongation of ABR latencies.

Effectiveness of the Neuroimaging Techniques in the Recognition of Psychiatric Disorders: A Systematic Review and Meta-analysis of RCTs.

Neuroimaging has helped us learn about the stages of brain development from infancy to maturity. Neuroimaging helps physicians diagnose mental illnesses and find novel treatments for them. It can distinguish depression from neurodegenerative diseases or brain tumors, and it can reveal structural defects that cause psychosis. Psychosis has been linked to lesions in the frontal or temporal lobes of the brain, as well as the thalamus and hypothalamus, which can be detected using a brain scan for mental illnesses. Neuroimaging uses quantitative and computational methods to explore the central nervous system. It can detect brain injuries and psychological illnesses. Thus, a systematic review and meta-analysis of randomized controlled trials using neuroimaging to detect psychiatric disorders assessed their efficacy and benefits. Appropriate articles were searched from PubMed, MEDLINE, and CENTRAL databases using the appropriate keywords as per the PRISMA guidelines. Randomized controlled trials and open-label studies were included as per the predefined PICOS criteria. Meta-analysis was performed using the RevMan software, and statistical parameters like odds ratio and risk difference were calculated. Twelve randomized controlled clinical trials with a total of 655 psychiatric patients were included following the criteria from the year 2000 to 2022. We included studies that use different neuroimaging techniques for the detection of organic brain lesions that would help diagnose psychiatric disorders. The primary outcome was detecting brain abnormalities in diverse psychiatric illnesses with neuroimaging versus conventional methods. We found the odds ratio value of 2.29 (95% CI 1.49-3.51). The results were heterogeneous with a Tau2 value of 0.38, chi2 value of 35.48, df value of 11, I2 value of 69%, the z value of 3.78, and p-value less than 0.05. The risk difference is 0.20 (95% CI 0.09 -0.31) with heterogeneity of Tau2 value of 0.03, chi2 value of 50, df value of 11, I2 value of 78%, the z value of 3.49, and p-value less than 0.05. The present meta-analysis strongly recommends the use of neuroimaging techniques for the detection of psychiatric disorders.

Sturge Weber Syndrome Roach Type I: A case report

Convulsion is a serious neurological symptom with diverse underlying etiology ranging from metabolic causes to organic brain lesions. Congenital neuro-cutaneous syndromes are rare causes of seizures that manifest with specific external features. This article reports a 22-year-old man born to non-consanguine parents, who presents with recurrent seizures commencing at the age of one year along with thephysical sign of capillary hemangioma on the right side of theface and radiological evidence of ipsilateral subcortical calcification in the brain. These features constitute the diagnosis of a rare neuro-cutaneous disorder, the Sturge-Weber syndrome, a classical variant, the Roach Type I.

The diagnosis to be kept in mind in resistant epilepsy; tuberous sclerosis

Drug-Resistant Epilepsy is the continuation of seizures despite administering two tolerable antiepileptic drugs at the appropriate dose and time, which are selected according to the type of seizure. Growth retardation, focal neurological findings, organic brain lesions, specific EEG disorders, and epilepsy in the family are risk factors for resistant epilepsy. Tuberous sclerosis is a multisystemic and autosomal dominant genetic disease with hamartomas in many organs such as the skin, central nervous system, kidney, and lungs. Brain hamartomas and other central nervous system lesions cause resistant epilepsy in tuberous sclerosis. In this article, we present a 16-year-old patient with tuberous sclerosis who was followed up with the diagnosis of resistant epilepsy, despite typical physical examination findings. This research emphasised that tuberous sclerosis should be kept in mind in the aetiology of resistant epilepsy and how important physical examination is.

To substantiate the functional diagnosis of organic mental disorder in forensic psychiatric practice

The vegetative reactions using functional tests (correlation rhythmography and electronic conduction) were studied in 165 inpatient men with organic brain lesions during forensic and psychiatric examination. These methods can be used in expert practice

Postoperative agitation syndrome in young children with perinatal damage to the central nervous system

One of the complications of the postoperative period in children is postanesthetic agitation, a significant emotional and uncontrollable worry, clouding of consciousness, feeling of anxiety and fear, inappropriate behavior, irritability, inconsolable crying, aggressive and negative attitude towards parents and medical staff. Postoperative agitation is very important for clinicians and hospitals, it has a risk of harming a patient, staying longer in the ward after anesthesia, and increasing the period of postoperative recovery. The frequency of postoperative agitation depends on age group. Most often agitation occurs in young children. There is evidence that agitation can also be due to the immature nervous system and a consequence of pathological conditions of the central nervous system (asthenoneurotic syndrome, encephalopathy, hyperactivity syndrome, perinatal posthypoxic and organic brain lesions, history of prematurity, epilepsy, psychophysical and speech delay, etc.). That is why the goal of our research was to study the patterns of clinical manifestations of postoperative agitation syndrome in children with prenatal damage to the central nervous system. The work was performed based on the analysis of the postoperative period in 109 young children: 59 patients with acquired hydrocephalus, who underwent ventriculoperitoneal shunting, and 50 children without neurological disorders in whom reconstructive surgeries were carried out. Depending on the type anesthetic management, each group was divided into two subgroups: children, who received inhalation anesthesia with sevoflurane, and those, who received total intravenous anesthesia using propofol. In the postoperative period, the behavior of children was assessed on a Pediatric Anesthesia Emergence Delirium scale 30 minutes after anesthesia was completed. Criterion for the development of agitation was the presence of excitement in a child with a score of ≥ 10 points. Study showed that young children with perinatal damage to the central nervous system and children whose anesthetic provision is carried out using sevoflurane are the most vulnerable to the development of agitation syndrome. Agitation in such children is more pronounced and longer. These cases require prediction, detection and active surveillance.

Comorbidity in Servicemen – Participants of Modern Military Conflicts

The professional health of a serviceman is the absence of diseases in the presence of a certain level of compensatory and protective mechanisms that ensure high combat effectiveness in the conditions of his professional activity. That is why the most important component of the national security system of our country is the protection and strengthening of the health of military personnel. In recent years, armed conflict has continued in the east of Ukraine. Therefore, today’s urgent task is to study the features of comorbid diseases that may be primary to modern combat trauma in military personnel participating in the anti-terrorist operation / Joint Forces Operation (ATO / JFO). Comorbid diseases have a negative impact on the course of modern combat trauma, as well as combat trauma has a negative impact on the course of these diseases. The objective: to analyze the frequency of comorbid diseases in military personnel – participants in the ATO / JFO, depending on the presence of a closed craniocerebral injury (CTBI). Materials and methods. The study was performed in the Ukrainian Military Medical Academy based on the National Military Medical Clinical Center “Main Military Clinical Hospital” where 183 servicemen – participants of the ATO / JFO with arterial hypertension (AH) were examined. Patients were divided into two statistically homogeneous groups according to age: group I – 127 people who, while participating in the ATO / JFO, did not receive CTBI, group II – 56 people with such injury. Statistical analysis of the results was done by use of the standard statistical package STATISTICA 10.0 for Windows from StatSofr Inc. (USA) using parametric statistical methods. Results. In military personnel participating in the ATO/JFO, there was no correlation between the severity of hypertension and the presence of a cranio-cerebral injury. At the same time, in subjects with CTBI, there was an increase in the frequency of comorbid diseases of the nervous system and diseases of the ear and mammillary process and a decrease in the frequency of comorbid endocrine and metabolic diseases and diseases of the genitourinary system compared to patients without such an injury. Patients with CTBI have an increase in the frequency of acubarotrauma and sensorineural hearing loss and a decrease in the frequency of urolithiasis compared with military personnel without CTBI. Conclusions. The study established the features of comorbid diseases in military personnel – participants in modern military conflicts, depending on the presence of a closed craniocerebral injury. This information is important for the further medical and social rehabilitation and development of proper functional-organizational model of secondary prevention of this comorbid pathology in order to prolong the professional longevity of highly professional military personnel. It is necessary to study further the influence of organic (traumatic) brain lesions over time on the morphogenesis of arterial hypertension and comorbid diseases, and their combination in military personnel participating in the ATO/JFO.

Hypersexuality as a Manifestation of Various Disorders

The article deals with hypersexuality, which can be a manifestation of a wide variety of disorders. These include: consequences of a psychotrauma; premature psychosexual development; borderline personality disorder; submaniac and maniac states in bipolar affective disorder and schizoaffective type of the course of schizophrenia; disinhibition of libido, rough and naked eroticism in the initial stage of schizophrenia; consequence of advanced emotional volitional disorders in simple-type schizophrenia; temporal lobe epilepsy; dementia; mental retardation (oligophrenias); various organic brain lesions (resulting from neuroinfections, injuries, vascular damages, neoplasms) [the temporal and frontal lobes of the brain are indicated as regulators of libido]; consequence of disorders in the hypothalamic area and limbic system. It is reported that a correlation exists between development of hypersexuality and damages in certain cerebral areas in patients with non-traumatic brain damage. It is pointed out that hypersexuality may result from maldevelopment of the right hippocampus, anti-NMDA receptor encephalitis, in patients with disseminated sclerosis, Huntington’s disease, Kluver-Bucy syndrome as well as be caused by various hormonal disorders and consequences of premenstrual changes and effect of virilizing hormones during the childhood or intrauterine period. Numerous clinical illustrations of cases with hypersexuality, caused by various disorders, are given. The author holds the opinion that it is necessary to divide hypersexuality at least into two categories: true hypersexuality and sexual disinhibition, when with the normal or even reduced level of libido manifestation the hypersexual behaviour results from absence or insufficiency of inhibitory mechanisms (for example, in dementia).

ОСОБЕННОСТИ ЛУЧЕВОЙ КАРТИНЫ ГОЛОВНОГО МОЗГА И ВНУТРЕННИХ ОРГАНОВ НОВОРОЖДЕННЫХ, ПЕРЕНЕСШИХ ТЯЖЕЛУЮ ПЕРИНАТАЛЬНУЮ АСФИКСИЮ И ПОДВЕРГШИХСЯ ОБЩЕЙ ТЕРАПЕВТИЧЕСКОЙ ГИПОТЕРМИИ, ПО РЕЗУЛЬТАТАМ ПИЛОТНОГО ИССЛЕДОВАНИЯ

Objective of the research: to study the features of the radiological picture of the brain and internal organs of newborns with severe perinatal asphyxia, who underwent general therapeutic hypothermia (GTH). Materials and methods: the study included 116 newborns with severe perinatal asphyxia. GTH was performed in 72 patients (group 1), 44 children did not receive hypothermia in the 2 (control) group. In the first 6 hours of life, children of groups 1 and 2 underwent ultrasound of the brain and abdominal organs and chest x-ray. The complex ultrasound scan was repeated at 3–5, 7–10, 14–16 and 21–28 days. Repeated chest x-ray was carried out strictly according to the indications. Results: GTH reduced the incidence of organic brain lesions by 18% in children with severe perinatal asphyxia (p0,05). The study revealed a number of undesirable consequences associated with GTH. Transient effusion into the abdominal and thoracic cavities was diagnosed by ultrasound in 8 (11%) patients after hypothermia, while there were no such changes in children in the control group (p<0,05). X-ray of the chest in newborns who received GTH during the first 14 days revealed edematous-hemorrhagic changes in the lungs more often than in patients of the control group – 55 (76%) and 24 (55%), respectively (p<0,05). Conclusions: GTH effectively prevented the development of severe post-hypoxic changes in the brain. The negative effect of hypothermia on microcirculation was manifested by the development of effusion into the serous cavities and edematous-hemorrhagic syndrome.

Differences in the cognitive status of patients with schizophrenia depending on the genesis of concomitant encephalopathy

To analyze the cognitive status of patients with schizophrenia and organic cerebral pathology of various genesis. The study included 75 patients diagnosed with paranoid schizophrenia (F20.0). Depending on the type of organic brain lesion, all patients were divided into four groups: patients with paranoid schizophrenia without organic brain pathology (n=41), patients with dyscirculatory encephalopathy (n=15), patients with post-traumatic encephalopathy (n=12), patients with toxic encephalopathy (n=7).The Brief Assessment of Cognition in Schizophrenia (BACS) and the Rey-Osterrieth Complex Figure (ROCF) followed by the evaluation of the results with the Boston Qualitative Scoring System (BQSS)were used to assess the cognitive status. Patients with schizophrenia without concomitant cerebral pathology had a better state of the cognitive sphere compared to patients whose underlying disease was aggravated by encephalopathy of various genesis. In particular, it applied to such cognitive functions as verbal memory, speech fluency, problem-solving behavior, long-term visual-motor memory, organization and constructive ability. According to the results of this study, patients with posttraumatic encephalopathy had the least pronounced cognitive deficit among patients with an organic brain lesion. In turn, patients with toxic encephalopathy had the worst indicators of the state of the cognitive sphere.

Reinterpretation of magnetic resonance imaging findings with magnetoencephalography can improve the accuracy of detecting epileptogenic cortical lesions

ObjectiveThis study examined whether the application of magnetoencephalography (MEG) to interpret magnetic resonance imaging (MRI) findings can aid the diagnosis of intractable epilepsy caused by organic brain lesions. MethodsThis study included 51 patients with epilepsy who had MEG clusters but whose initial MRI findings were interpreted as being negative for organic lesions. Three board-certified radiologists reinterpreted the MRI findings, utilizing the MEG findings as a guide. The degree to which the reinterpretation of the imaging results identified an organic lesion was rated on a 5-point scale. ResultsReinterpretation of the MRI data with MEG guidance helped detect an abnormality by at least one radiologist in 18 of the 51 patients (35.2%) with symptomatic localization-related epilepsy. A surgery was performed in 7 of the 51 patients, and histopathological analysis results identified focal cortical dysplasia in 5 patients (Ia: 1, IIa: 2, unknown: 2), hippocampal sclerosis in 1 patient, and dysplastic neurons/gliosis in 1 patient. ConclusionsThe results of this study highlight the potential diagnostic applications of MEG to detect organic epileptogenic lesions, particularly when radiological visualization is difficult with MRI alone.

Comparative Evaluation of Conventional and Advanced Magnetic Resonance Imaging (MRI) Sequences in Mesial Temporal Lobe Sclerosis Patients with Seizure

Background: Diffusion Tensor Imaging (DTI) is a new noninvasive dimension of magnetic resonance imaging (MRI) that provides insight into the white matter microstructure. In epilepsy, widespread DTI abnormalities have been reported in multiple studies in medical literature. In mesial temporal lobe sclerosis (MTLS) patients, conventional MRI may show enlargement of ipsilateral temporal horn & reduction in volume of hippocampus in later stages of disease. However, DTI has been found to be useful in demonstrating the focus of epileptiform activity in brain especially in white matter very early in disease. Since DTI is a sensitive technique to detect subtle structural abnormalities causing epilepsy, hence it can be used to plan more successful epilepsy surgery. Therefore, we conducted a pilot study on twenty patients with seizure disorder using DTI where focal organic brain lesions were ruled-out. Aim: To assess the role of DTI in patients of MLTS with seizures.Subjects and Methods:Twenty patients with seizure disorder secondary to MLTS were evaluated using conventional MRI and DTI. We compared the final diagnosis achieved by clinical parameters correlated with EEG localization.Results:Ten out of twenty patients revealed abnormality on DTI that correlated with EEG correlation without obvious abnormality on conventional MRI representing a significant impact of DTI.Conclusion: DTI can sensitively detect structural changes in MLTS with epilepsy often undetectable on conventional MRI. Hence, DTI can serve as an important radiological tool guiding in management and presurgical evaluation of epilepsy patients considered as idiopathic or and refractory medication.

Organic Lesions in the Brain MRI of Children with Febrile Seizure.

Seizure is the most common neurological disorders in children, where 4-10% of the cases experience at least one seizure before the age of 16. The most frequent causes of seizures in children are fever, epilepsy, infection and brain damage. The aim of this study was to investigate the frequency of organic lesions in MRI of children with seizures unrelated to fever. This cross-sectional study included children presented with fever-unrelated seizures. The MRI was examined by a radiologist to identify abnormal findings in each patient. A researcher-made questionnaire including general information, history of head trauma, obstructed labor and the history of seizure was completed for the patients. Of 287 children with fever-related seizure, 127 (45.7%) were male and 151 (54.3%) were female. History of seizure, history of obstructed labor, abnormal MRI, complete delay, use of antiepileptic drug and history of trauma were 22(9.9%), 1 (0.4%), 11(4%), 5(1.8%), 259(93.2%) and 12 (4.3%), respectively. Of 11 patients with abnormal MRI, 4 had MTS lesions, 2 had tumor lesions, 2 had scarring trauma, 1 had an epidural abscess and 1 had meningitis. The frequency of organic lesions had no significant differences based on gender, use of antiepileptic drug and traumatic history, but it had a significant relation with obstructed labor andthehistory of seizure. The results showed that organic brain lesions in children with fever-unrelated seizure had a significant relationship with the history of seizure and obstructed maternal labor.

Multiple Cranial Nerve Palsies, Without Definitive Brain Lesion. Rare Case of Plasma Cell Myeloma

Plasma cell myeloma rarely presents with neurological symptoms, and if this happens then cause is usually plasmacytoma. This is a very rare case to be presented as multiple cranial nerve palsies, unusual presentation of plasma cell myeloma without involvement of organic brain lesion in literature to date. A 70 years old gentleman having ESRD, was received with diplopia, deviation of angle of mouth, on and off chest pain. Investigations ruled out stroke, cardiac event, autoimmune process or any other possible cause of cranial nerve palsies. Diagnosis of multiple myeloma was confirmed by immune electrophoresis which showed monoclonal gammopathy, punched out lytic lesions were found on skeletal scurvy and later confirmation was done by bone marrow biopsy for the presence of plasma cell myeloma. Key words: plasma cell myeloma, cranial nerve palsies

Acute Psychosis Precipitated by Urinary Tract Infection in a Patient with Gliosis of the Basal Ganglia.

Background:Urinary tract infections (UTI) have been found to be associated with a variety of neuropsychiatric disorders, and could play a role in the pathophysiology of relapse of affective and nonaffective psychosis. In addition, prior history of infarction in areas of the brain such as the cerebellum, basal ganglia, and mid-brain have been reported in patients with new onset psychotic symptoms.Case presentation:A 29-year-old woman was brought to the hospital with acute mental status changes and signs of sepsis. Infectious work-up was initiated including blood cultures, brain imaging, lumbar tap and urinalysis. Brain MRI revealed abnormalities in the basal ganglia and the urinalysis revealed signs of a urinary tract infection (UTI). Further history revealed episodes of mania and depression compatible with bipolar disorder with psychotic features that had acutely worsened. The patient’s condition improved with intravenous antibiotics and the introduction of anti-psychotics. She was discharged in stable condition with outpatient psychiatric follow-up.Conclusion:Infectious diseases (UTIs in particular) are not only more prevalent among patients with acute relapse of psychiatric disorders, but have also been found to have triggered acute psychosis among stable psychiatric patients. Organic brain lesions must be thoroughly investigated among patients presenting with new psychiatric disorders in order to initiate appropriate therapy to control the symptoms.