Naslov
Psychiatric manifestations of multiple sclerosis and acute disseminated encephalomyelitis

Autori
Habek, Mario ; Brinar, Vesna V. ; Brinar, Marko ; Poser, Charles M.

Izvornik
Neurologia Croatica. Supplement (1331-5196) 54 (2005), 1;

Vrsta, podvrsta i kategorija rada
Radovi u časopisima, kongresno priopcenje, znanstveni

Ključne riječi
Disseminated encephalomyelitis; Multiple sclerosis; Psychosis; Depression; Generalized anxiety disorder

Sažetak
Background: It is unusual for acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) to present as purely psychiatric disorders. We present 5 patients with ADEM or MS and symptoms of psychosis, depression or anxiety. Case reports: First two patients presented as a new-onset psychosis, with cognitive impairment in patient 2. Brain MRI in both cases revealed large areas of increased signal intensity on T2-weighted images, a finding characteristic for ADEM. CSF analysis showed intratecal gamma globulin synthesis with positive oligoclonal bands. A 53 year old MS patient developed paranoid psychosis and persecutory delusions. Brain MRI revealed two demyelinating lesions in right parietal cortex with gadolinium enhancement. Patient 4 developed symptoms of major depression after childbirth. Brain MRI revealed multifocal demyelinating lesions and oligoclonal bands were positive. Patient 5 had symptoms of generalized anxiety disorder and was diagnosed with postinfectious ADEM. Discussion: Data from our patients are highly suggestive of a causative link between demyelination and psychiatric symptoms. First three patients presented with predominantly psychiatric symptoms and had MRI and CSF findings which pointed to the ADEM or MS. Similarly, subcortical white matter lesions in patient 4 are in concordance with previous findings that cortical-subcortical disconnection is responsible for depression in demyelinating disorders. Although in many patients anxiety is merely a reactive response to the diagnosis, clinical picture of patient 5 is suggestive of connection between anxiety symptoms and MS. Conclusion: These cases highlight the fact that significant proportion of all psychiatric patients has underlying demyelination requiring specific diagnostic work-up and therapy.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA