目前的文献显示,很少有关于动静脉畸形患者出现躁狂症状的病例报告,没有其他诱发因素。这些病例在开始治疗前出现躁狂症。我们报道了一例罕见的46岁男性患者,放射治疗后有左动静脉畸形(AVM)状态并伴有癫痫发作,他因急性躁狂症和其他行为改变向当地医院急诊科就诊。病人有躁狂症状,包括情绪不稳定,冲动,失眠,食欲下降,嫉妒妄想症,有压力的演讲,和自杀的想法。患者抑郁症的艾司西酞普兰剂量从20毫克减少到10毫克,在入院时开始使用丙戊酸盐。住院三天后,他的精神症状逐渐好转。随后,他出院回家,并得到了进一步的指示,以跟进他的神经科医生。在这个案例报告中,我们表明,器质性躁狂障碍应该考虑在任何躁狂患者出现在通常的发病年龄以外的特发性躁狂抑郁症,缺乏家庭或个人情感障碍史,或表现出伴随的神经缺陷。此外,我们强调,对于出现急性躁狂症的患者,区分原发性精神病和继发于医学原因的精神病可显著影响患者接受的护理,并可对其精神病和医学预后产生影响.
Current literature shows very few case reports about manic symptoms arising in patients with arteriovenous malformations and no other predisposing factors, where these cases presented with mania before the initiation of treatment. We report a rare case of a 46-year-old male patient, with a history of a left arteriovenous malformation (AVM) status post radiation treatment with associated seizures, who presented to the emergency department of a local hospital with acute mania and other behavioral changes. The patient had manic symptoms, including mood lability, impulsivity, insomnia, decreased appetite, jealous delusions, pressured speech, and suicidal ideations. The patient\'s escitalopram dose for depression was reduced from 20 mg to 10 mg, and valproate was started during admission. After a three-day hospital admission, his psychiatric symptoms gradually improved. He was subsequently discharged home with additional instructions to follow up with his neurologist. In this case report, we show that organic manic disorder should be considered in any manic patient who presents outside the usual age of onset for idiopathic manic-depressive disease, lacks a family or personal history of affective disturbance, or exhibits concomitant neurologic deficits. In addition, we emphasize that distinguishing between primary psychiatric conditions and those secondary to medical causes for patients who present with acute mania can significantly impact the care a patient receives and can make a difference in their psychiatric and medical prognosis.