Clinical case! π§ ππ§΅
1/7 A 26-year-old woman from a rural region of Mexico presented in a state of catatonia. At age 21, she begun to exhibit aggressiveness. At age 23, she started having difficulties handling money, she constantly misplaced things. Sometimes she was disoriented
1/7 A 26-year-old woman from a rural region of Mexico presented in a state of catatonia. At age 21, she begun to exhibit aggressiveness. At age 23, she started having difficulties handling money, she constantly misplaced things. Sometimes she was disoriented
2/7 At age 26, 2 days after delivering her first child, she had a (first) psychotic episode, with incoherent speech, disorganized behavior, aggressiveness, visual & auditory hallucinations. She neglected her newborn, saying repeatedly that the child was not hers.
3/7 Psychotic symptoms were mixed with periods of catatonia. She recieved risperidone 2 mg/day, which worsened the catatonic states. She was referred to our hospital. On admission, risperidone was suspended. We observed immobility, mutism, staring, posturing, waxy flexibility...
4/7 The Bush-Francis Catatonia Rating Scale severity score was 26. A cognitive examination was not possible at that time due to catatonia. Routine laboratory studies, cerebrospinal fluid examination, and the EEG study were normal. Magnetic resonance imaging scans are shown below.
5/7 Family history revealed that the patientβs father &
several relatives had an undiagnosed illness characterized by choreoathetotis, aggressiveness, & cognitive decline. We evaluated her father and found prominent choreoathetotic movements & dementia.
several relatives had an undiagnosed illness characterized by choreoathetotis, aggressiveness, & cognitive decline. We evaluated her father and found prominent choreoathetotic movements & dementia.
6/7 Polymerase chain reaction confirmed Huntington Disease in our patient, with 17/45 cytosine-arginine-guanine repeats at the Huntington gene in the 4p chromosome. After improvement of catatonia, she had bradykinesia & dystonia, instead of choreoathetosis
7/7 She remains stable on maintenance with lorazepam, amantadine and levodopa/carbidopa. Unfortunately, HD is progressive, leads to dementia & eventually death.
Source: pubmed.ncbi.nlm.nih.gov
Neuropsychiatric symptoms are common in movement disorders:
pubmed.ncbi.nlm.nih.gov
Source: pubmed.ncbi.nlm.nih.gov
Neuropsychiatric symptoms are common in movement disorders:
pubmed.ncbi.nlm.nih.gov
pubmed.ncbi.nlm.nih.gov/32071931/
Nosology and Phenomenology of Psychosis in Movement Disorders - PubMed
Psychosis is a frequent comorbidity in most hyper- and hypokinetic movement disorders. Appropriate r...
pubmed.ncbi.nlm.nih.gov/22123587/
Westphal variant Huntington disease and refractory catatonia: a case report - PubMed
A young woman with Westphal variant (juvenile) Huntington disease (HD) also developed catatonia. Cat...
We learned many things from this case. Neurological patients with movement disorders may present with unexpected psychiatric disturbances & worsening with antipsychotics may be considered a red flag
#Neuropsychiatry #Neurology #Psychiatry #Neuroscience #NeuroTwitter #PsychTwitter
#Neuropsychiatry #Neurology #Psychiatry #Neuroscience #NeuroTwitter #PsychTwitter
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