Delusional infestation in a patient with posterior reversible encephalopathy syndrome

Tsai, Shi-Jen; Yeh, Chin‐Bin; Wang, Chih‐Wei; Mao, Wei-Chung; Yeh, Ta‐Chuan; Tai, Yueh‐Ming; Lee, Yen-Feng; Chang, Hsin‐An; Kao, Yu Hsun; Tzeng, Nian‐Sheng

doi:10.1177/0004867416656259

Cited by 7 publications

(3 citation statements)

References 5 publications

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“…In rare occasions, myelopathic symptoms and signs from spinal cord involvement have been demonstrated (40). Other uncommon presentations include abulia, agitation, delusions, ophisthotonus, optic ataxia, ocular apraxia, and simultagnosia (41)(42)(43)(44).…”

Section: Uncommon Clinical Manifestationsmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome

2020

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Background: Posterior reversible encephalopathy syndrome (PRES) is an acute neurotoxic syndrome that is characterized by a spectrum neurological and radiological feature from various risk factors. Common neurological symptoms includes headache, impairment in level of consciousness, seizures, visual disturbances, and focal neurological deficits. Common triggering factors include blood pressure fluctuations, renal failure, eclampsia, exposure to immunosuppressive or cytotoxic agents and autoimmune disorders. The classic radiographic findings include bilateral subcortical vasogenic edema predominantly affecting the parieto-occipital regions but atypical features include involvement of other regions, cortical involvement, restricted diffusion, hemorrhage, contrast enhancement. This review is aimed to summarize the updated knowledge on the typical and atypical clinical and imaging features, prognostic markers and identify gaps in literature for future research. Methods: Systematic literature review using PUBMED search from 1990 to 2019 was performed using terms PRES was performed. Results: While clinical and radiographic reversibility is common, long-standing morbidity and mortality can occur in severe forms. In patients with malignant forms of PRES, aggressive care has markedly reduced mortality and improved functional outcomes. Although seizures were common, epilepsy is rare. Various factors that have been associated with poor outcome include altered sensorium, hypertensive etiology, hyperglycemia, longer time to control the causative factor, elevated C reactive protein, coagulopathy, extensive cerebral edema, and hemorrhage on imaging. Conclusion: Large prospective studies that accurately predict factors that are associated with poor outcomes, determine the pathophysiology, and targeted therapy are required.

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Section: Uncommon Clinical Manifestationsmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome

2020

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“…Although present for only a brief period, these symptoms suggest that the temporal and frontal lobes may have also been affected [ 7 ]. While there are no reports of auditory hallucinations, there have been single case reports of tactile hallucinations and delusional infestation in PRES patients [ 8 - 9 ]. Another unique aspect of his presentation was the severity of his aggression during the finger biting episode.…”

Section: Discussionmentioning

confidence: 99%

Hypertensive Encephalopathy: A Case of a Male Who Bit Off His Fingers

Kim

Syed

2017

Cureus

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Although altered consciousness and other neurologic manifestations are frequently seen in hypertensive encephalopathy, behavioral and psychotic symptoms are rarely seen. We describe a patient with no previous psychiatric history who was admitted for hypertensive crisis. A few days after admission, his blood pressure remained uncontrolled and he started to exhibit episodes of confusion, agitation, and psychosis. During one particular episode, he overcame multiple staff members and physical restraints to bite off two of his fingers without any signs of pain. Brain computed tomography (CT) was notable for possible posterior cerebral and cerebellar edema. His confusion and agitation gradually resolved with successful blood pressure management. This is the first reported case of extreme, agitated behaviors and auditory hallucinations in a patient with hypertensive crisis.

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“…An improved understanding of the physiopathology of DP may result from the relationship between impaired belief evaluation (e.g., frontal cortex) and abnormal cortical processing (e.g., parietal cortex) [132]. Another neurological disease that can hide under the sequelae of DP is posterior reversible encephalopathy syndrome, which is a syndrome of transient vasogenic edema over the white matter of the cerebral posterior regions [133].…”

Section: Secondary Dpmentioning

confidence: 99%

Insights into the Medical Evaluation of Ekbom Syndrome: An Overview

Mindru,

Radu,

Bumbu

et al. 2024

IJMS

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Ekbom syndrome, also known as delusional parasitosis (DP) or delusional infestation, is an uncommon psychiatric disorder distinguished by an enduring conviction of parasitic infestation, persisting notwithstanding the presence of medical evidence to the contrary. Primarily affecting middle-aged women, DP can manifest either as isolated psychological distress or as a component within a more intricate psychiatric framework, substantially influencing the quality of life for affected individuals. Its pathophysiological mechanism involves uncertain dopaminergic imbalances and dysfunction in the dopamine transporter system. Dermatologists often play a pivotal role in diagnosis, as patients first seek dermatological assessments of their signs and symptoms. However, DP frequently originates from underlying psychiatric disorders or medical variables, manifesting with neurological and infectious causative factors. The diagnostic complexity is attributed to patients’ resolute convictions, leading to delayed psychiatric intervention. First-line DP treatment involves antipsychotics, with newer agents demonstrating promising prospects, but the lack of standardized protocols poses a significant therapeutic challenge. In this narrative review, both a comprehensive approach to this uncommon pathology and an update on the state of knowledge in this medical subfield focused on optimizing the management of DP are provided. The complexity of DP underlying its uncommon nature and the incomplete understanding of its pathophysiology highlight the need for further research through multicenter studies and multidisciplinary teams to enhance therapeutic efficacy and safety.

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Delusional infestation in a patient with posterior reversible encephalopathy syndrome

Cited by 7 publications

References 5 publications

Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome

Posterior Reversible Encephalopathy Syndrome: Clinical Features and Outcome

Hypertensive Encephalopathy: A Case of a Male Who Bit Off His Fingers

Insights into the Medical Evaluation of Ekbom Syndrome: An Overview

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