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- Title
Psychosis with olfactory hallucination or complex partial seizure? A case with herpes simplex encephalitis sequelae and coincidental parasagittal meningioma.
- Authors
AKÇAY, Elif; KARADAĞ, Filiz
- Abstract
Objective: Temporal lobe dysfunctions which are associated with the organic brain lesions or epileptic discharges can be presented as psychosis. Encephalitis due to herpes simplex virus infection often damage temporal lobe. After herpes simplex encephalitis (HSE), psychiatric and behavioral symptoms have been found approximetly 80% of the survivors. We describe a case presented with psychotic symptoms including paranoid delusions and olfactory hallucina-tion after HSE and she also had simultaneously a parasagittal meningioma. Case: Ms. A, a 60-year-old woman, admitted to hospital because of bad smelling, nausea, retching for hours, paranoid delusions, insomnia, hitting on her head hardly, and forgetfulness. She had HSE history three years ago that damage to the bilateral temporal lobe. Insomnia and paranoid delusions emerged after five months acute encephalitis, olfactory hallucinations began last seven months. In our clinic, she was started olanzapine 5-30 mg/day with the initial diagnosis of psychotic disorder due to HSE. Awake EEG showed excessive theta rhythms (5-7 Hz) on bilateral parasagittal regions that consistent with parasagittal meningioma which was stable for ten years. Her paranoid symptoms and olfactory hallucinations persisted despite three antipsychotic trial (30 mg/day olanzapine for two weeks, risperidone (2-8 mg/ day) for ten day and finally sulpiride 200-600 mg/day for 3e weeks). During hospitalization, we noticed that her paranoid delusions, olfactory hallucinations associated with agitation and hostile attitude seemed to have periodic pattern in the day. Despite lack of any clinical signs of seizure, we started carbamazepine (200-800 mg/day) and sulpiride dosage reduced taking into consideration the intermittent nature of psychotic symptoms may be an epileptic phenomena. After 2 weeks, her psychotic symptoms and disrupted behaviors were completely improved. Discussion: In the literature, case reports which characterized by starting in the late period with psychotic and behavioral problems as in our case are documented less. The case defined by Gaber and Eshietti had similar features with our case who was hospitalized during seven months and nonresponsive to antipsychotic drugs. Despite the absence of any EEG abnormalities in their case, the patient responded dramatically to carbamazepine as in our case. Another case responded to carbamazepine treatment for psychiatric symptoms has been reported by Vallini et al. in the literature. In this case, although clinical or neurophysiological evidence of seizure are not, nonresponsive to antipsychotic treatment and im-provement of the symptoms after carbamazepine ther-apy are suggested that carbamazepine would be help-ful for patients have treatment-resistant psychotic symptoms characterized by episodic features after HSE.
- Publication
Anatolian Journal of Psychiatry / Anadolu Psikiyatri Dergisi, 2016, Vol 17, p31
- ISSN
1302-6631
- Publication type
Article