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Tsuchida A, Sawada K. Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2024; 3:e191. [PMID: 38868082 PMCID: PMC11114290 DOI: 10.1002/pcn5.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 03/15/2024] [Accepted: 03/20/2024] [Indexed: 06/14/2024]
Abstract
Background Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is increasingly recognized as a clinicoradiological syndrome. Its etiology is diverse, encompassing a variety of triggers, including infections and metabolic abnormalities. Uniquely, MERS may present with psychiatric symptoms, such as delirium, visual hallucinations, and catatonia, posing diagnostic challenges. The variability of these neuropsychiatric symptoms necessitates early diagnosis through magnetic resonance imaging (MRI) to avoid prolonged antipsychotic treatment. Case Presentation This report details a case of MERS in a 39-year-old male. The patient initially presented with headache, sore throat, and abnormal laboratory results: leukocytosis, neutrophilia with a left shift, elevated C-reactive protein (CRP) levels, and hyponatremia. On the fourth day of admission, he developed severe anxiety and restlessness, exhibited thoughts of death, and reported experiencing vivid hallucinations upon closing his eyes. MRI revealed a hyperintense lesion in the corpus callosum. A lumbar puncture showed no increase in cell count or protein. The patient showed a positive response to treatment with antibiotics and olanzapine, demonstrating rapid symptomatic improvement. A follow-up MRI on the 11th day showed complete resolution of the brain lesions. Six months later, no neurological or psychiatric sequelae were noted. The patient's clinical progression and imaging findings led to a definitive diagnosis of MERS. Conclusion The early presentation of symptoms such as restlessness, hallucinations, and death ideation played a critical role in diagnosing MERS, with early MRI examination being instrumental in both diagnosis and preventing prolonged antipsychotic medication use.
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Affiliation(s)
- Aki Tsuchida
- Department of PsychiatryKochi Health Sciences CenterKochiJapan
| | - Ken Sawada
- Department of PsychiatryKochi Health Sciences CenterKochiJapan
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Dhungel O, Shrestha N, Sharma P, Pathak P, Sapkota N. Delirious Mania in an Elderly, Challenges in Diagnosis and Treatment. Case Rep Psychiatry 2023; 2023:8984062. [PMID: 38028755 PMCID: PMC10667045 DOI: 10.1155/2023/8984062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 12/01/2023] Open
Abstract
Delirious mania is an acute neurobehavioral syndrome which can have the features of mania, delirium, psychosis and catatonia. There are no diagnostic and treatment guidelines of delirious mania which can lead to delayed treatment, increasing morbidity and mortality. The primary goal of this report is to raise awareness among healthcare professionals and improve patient outcomes for this potentially life-threatening condition. In this case report, we present an octogenarian female, a case of bipolar disorder, current episode manic, who had impaired orientation, delusion of persecution, and altered sleep-wake cycle. She was treated with a combination of mood stabilizer and antipsychotic and discharged after 24 days of admission.
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Affiliation(s)
- Omkar Dhungel
- Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Najina Shrestha
- Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Pawan Sharma
- Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Pankaj Pathak
- Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
| | - Nidesh Sapkota
- Department of Psychiatry, Patan Academy of Health Sciences, School of Medicine, Lalitpur, Nepal
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Zhou J, Cao Y, Deng G, Fang J, Qiu C. Transient splenial lesion syndrome in bipolar-II disorder: a case report highlighting reversible brain changes during hypomanic episodes. Front Psychiatry 2023; 14:1219592. [PMID: 37492064 PMCID: PMC10363742 DOI: 10.3389/fpsyt.2023.1219592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 06/23/2023] [Indexed: 07/27/2023] Open
Abstract
Background Reversible splenial lesion syndrome (RESLES) is a rare neurological condition characterized by temporary abnormalities in the splenium of the corpus callosum, which has been reported in mental disorders. Previous studies on bipolar disorder (BD) primarily focused on aspects such as brain structure and function, neurochemical changes, and genetics. However, there have been no studies reporting the occurrence of this syndrome during hypomanic episodes and its disappearance during the remission phase in bipolar disorder type 2 (BD-II). Case presentation We present a case report of a 30 years-old female patient with BD-II who exhibited symptoms of RESLES during a hypomanic episode. The patient, with a 12 years psychiatric history, has experienced recurrent depressive episodes initially, with the first hypomanic episode occurring 8 years ago. During this period, this patient made several visits to the outpatient clinic to have her medications adjusted due to repeated suicide attempts. This time, she was admitted to our hospital with a second hypomanic episode due to drug withdrawal during pregnancy. The RESLES was observed on her brain magnetic resonance image, and it was alleviated after treatment with lithium carbonate and quetiapine until achieving remission. Conclusion We present the first report of identifying RESLES in BD-II with hypomanic episodes, which subsequently disappears during the remission phase. Our case report highlights a potential association between BD and RESLES, emphasizing the need for future studies to explore the underlying mechanisms connecting these two conditions in greater depth.
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Affiliation(s)
- Jingyuan Zhou
- Mental Health Center, West China Hospital of Sichuan University, Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Yuan Cao
- Mental Health Center, West China Hospital of Sichuan University, Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
- Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Jena, Germany
| | - Gaoju Deng
- Mental Health Center, West China Hospital of Sichuan University, Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
| | - Jinbo Fang
- West China School of Nursing, West China Hospital of Sichuan University, Chengdu, China
| | - Changjian Qiu
- Mental Health Center, West China Hospital of Sichuan University, Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, China
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Karoui M, Bouhlel E, Maatouk O, Labbene E, Ben Mohamed D, Bouaziz M. Adult mild encephalitis with reversible splenial lesion and catatonia: A case report. Heliyon 2022; 8:e10257. [PMID: 36072258 PMCID: PMC9441308 DOI: 10.1016/j.heliyon.2022.e10257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 02/27/2022] [Accepted: 08/05/2022] [Indexed: 11/29/2022] Open
Abstract
The relationship between corpus callosum and schizophrenia is elusive. Neuropsychiatric symptoms in Mild encephalitis with reversible splenial lesion (MERS) such as delirium, and negativism, suggest a link between corpus callosum and psychiatric disturbances. Here in, we report catatonia as an initial symptom of MERS in a schizophrenic patient. The aim of this study is to discuss the likely causal relationship between catatonic syndrome and MERS. To the best of our knowledge, the catatonia was not reported before as a prodromal symptom of MERS. We therefore report this case in order to enlarge the spectrum of MERS symptoms in psychiatric patients and discuss the relationship between catatonia and splenium lesions.
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Affiliation(s)
- Mehdi Karoui
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia
- Hôpital Razi, Service de Psychiatrie “G”, Tunisia
- Corresponding author.
| | - Emna Bouhlel
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia
- Institut Kassab, Service de Radiologie, Tunisia
| | - Ons Maatouk
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia
- Hôpital Razi, Service de Psychiatrie “G”, Tunisia
| | - Emna Labbene
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia
- Institut Kassab, Service de Radiologie, Tunisia
| | - Dina Ben Mohamed
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia
- Institut Mongi Ben HAmida, Service de Neurologie, Tunisia
| | - Mouna Bouaziz
- Université de Tunis El Manar, Faculté de Médecine de Tunis, 1007, Tunis, Tunisia
- Institut Kassab, Service de Radiologie, Tunisia
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Pereira Herrera M, Zimmerman AM. Case of refractory delirious mania responsive to lithium. BJPsych Open 2021; 7:e119. [PMID: 34184627 PMCID: PMC8269925 DOI: 10.1192/bjo.2021.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Delirious mania is an uncommon condition that is challenging to diagnose and treat. More often seen in patients with a history of bipolar disorder, it frequently presents with prominent catatonic features and overlaps with other diseases in the catatonic spectrum, such as neuroleptic malignant syndrome, serotonin syndrome and malignant catatonia. We present a case of delirious mania refractory to high doses of lorazepam, several antipsychotics and valproic acid, which responded dramatically to therapy with lithium after 26 days of minimal improvement with the other medications. The pathophysiology of delirious mania is reviewed, and the unique actions of lithium are discussed, highlighting possible reasons as to why lithium might offer advantages in the treatment of this disease.
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Chen YH, Xu Y, Wu H, Li XY, Zhang MJ. A new Ho(III) dinuclear complex: treatment activity and cure values on mania by reducing the expression of the ErbB4 on the noradrenergic neurons. INORG NANO-MET CHEM 2021. [DOI: 10.1080/24701556.2020.1808992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Yong-Hua Chen
- Department of Psychiatry, Zhoushan Second People's Hospital, Zhoushan, Zhejiang, China
| | - Yan Xu
- Department of Psychiatry, Zhoushan Second People's Hospital, Zhoushan, Zhejiang, China
| | - Hao Wu
- Department of Psychiatry, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiao-Yi Li
- Department of Psychiatry, Tongde Hospital of Zhejiang Province, Hangzhou, Zhejiang, China
| | - Ming-Jun Zhang
- Department of Psychiatry, Zhoushan Second People's Hospital, Zhoushan, Zhejiang, China
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Esposito CM, Buoli M, Ciappolino V, Agostoni C, Brambilla P. The Role of Cholesterol and Fatty Acids in the Etiology and Diagnosis of Autism Spectrum Disorders. Int J Mol Sci 2021; 22:ijms22073550. [PMID: 33805572 PMCID: PMC8036564 DOI: 10.3390/ijms22073550] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 02/07/2023] Open
Abstract
Autism spectrum disorders (ASDs) are a group of neurodevelopmental disorders whose pathogenesis seems to be related to an imbalance of excitatory and inhibitory synapses, which leads to disrupted connectivity during brain development. Among the various biomarkers that have been evaluated in the last years, metabolic factors represent a bridge between genetic vulnerability and environmental aspects. In particular, cholesterol homeostasis and circulating fatty acids seem to be involved in the pathogenesis of ASDs, both through the contribute in the stabilization of cell membranes and the modulation of inflammatory factors. The purpose of the present review is to summarize the available data about the role of cholesterol and fatty acids, mainly long-chain ones, in the onset of ASDs. A bibliographic research on the main databases was performed and 36 studies were included in our review. Most of the studies document a correlation between ASDs and hypocholesterolemia, while the results concerning circulating fatty acids are less univocal. Even though further studies are necessary to confirm the available data, the metabolic biomarkers open to new treatment options such as the modulation of the lipid pattern through the diet.
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Affiliation(s)
- Cecilia Maria Esposito
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Massimiliano Buoli
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Valentina Ciappolino
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
- Correspondence:
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via F. Sforza 35, 20122 Milan, Italy; (C.M.E.); (M.B.); (V.C.); (P.B.)
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
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Miller SM. Fluctuations of consciousness, mood, and science: The interhemispheric switch and sticky switch models two decades on. J Comp Neurol 2020; 528:3171-3197. [DOI: 10.1002/cne.24943] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Steven M. Miller
- Perceptual and Clinical Neuroscience Laboratory, Department of Physiology Monash Biomedicine Discovery Institute, School of Biomedical Sciences, Monash University Melbourne Victoria Australia
- Monash Alfred Psychiatry Research Centre Central Clinical School, Monash University and Alfred Health Melbourne Victoria Australia
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