22. European Stroke Conference 159 Interesting and challenging cases An Acute Transient Psychosis Following a Small Intracerebral Haemorrhage V.K. Bhalla1, R. Bhalla2 Broadmoor Hospital, West London Mental Health NHS Trust, London, UNITED KING-DOM1, Broadmoor Hospital, West London Mental Health NHS Trust, London, UNITED KING-DOM2 Background: Depression is the most prevalent post-stroke neuropsychiatric syndrome however, post-stroke psy-chosis seems to be much rarer. We present an interesting case of a patient who developed an acute, transient schizophrenia-like psychosis following a small intracerebral haemorrhage. Case Study: A 57 year old female with no past medical or psychiatric history presented with slurred speech. On arrival, she was found to be dysarthric and not dysphasic. She subsequently had a brief tonic-clonic seizure that terminated with lorazepam. A CT head showed a 19mm left temporo-parietal haemor-rhage and she was transferred to the stroke unit. On day 2, her GCS remained stable (15) and her dysarthria appeared to be slowly improving. On day 3, she accused the nursing staff of spying and laughing at her. She became aggressive and re-quired haloperidol for sedation. On day 4 she complained of cameras in the lights filming her. She was suspicious that patients opposite her were writing a diary about her and relatives secretly re-cording her. Her screening blood tests (electrolytes, calcium, TSH, inflammatory markers) and CXR were normal and mid stream urine negative. Her husband and daughter stayed with her for the next 2 days to reduce her agitation and paranoia. By day 7 she had become fully lucid. Bloods remained normal. Her MMSE: 30/30. She was discharged on day 8, with her dysarthria fully resolved. Discussion: It remains unclear why so few patients develop post-stroke psychosis. When delusions and halluci-nations are transient without causing distress, then drug treatment may not be indicated. Or as in our case study, environmental intervention trialled. If the psychosis is persistent, then psychotropics can be considered, as the risk of untreated psychosis may outweigh risks associated with antipsychot-ic medication. Although rare, post stroke psychosis is an important neuropsychiatric issue and the treatment of this disorder needs greater study. 366 © 2013 S. Karger AG, Basel Scientific Programme 160 Interesting and challenging cases Bilateral Restless Leg Syndrome Due to Unilateral Primary Hemorrhage in the Basal Ganglia V.K. Sharma1, G.H.T. Lim2, R. Rathkrishnan3, B.R. Wakerley4, L.L. Yeo5 National University of Singapore, Singapore, SINGAPORE1, Tan Tock Seng Hospital, Singa-pore, SINGAPORE2, National University Health System, Singapore, SINGAPORE3, National Uni-versity Health System, Singapore, SINGAPORE4, National University Health System, Singapore, SINGAPORE5 Background- Restless Legs Syndrome (RLS) occurs in about 10% patients with acute ischemic strokes involving the basal ganglia, pons, lateral thalamus, inter¬nal capsule or corona radiata. We describe a patient who developed bilateral RLS after a right basal ganglia hemorrhage. Case Description- A 58-year-old lady, previously known hypertensive, presented with left-sided weakness of sudden-onset. Upon arrival, she was drowsy and had blood pressure 170/110mmHg. Neurological evaluation revealed left hemiplegia, left hemianopia and dysarthria. Brain computed tomography (CT) showed a right basal ganglia hematoma with peri-lesional edema. Her level of consciousness improved during next 2 days. However, she complained of a progressively increasing need to move both lower limbs. This sensation was episodic, increased during periods of inactivity and she described relief after making the movements. RLS worsened at night, resulting in frequent awakenings during sleep. An electroencephalogram showed right hemispheric slowing but no ictal activity was noted during the leg movements. Blood tests, particularly thyroid function and renal function, were unremarkable. Electrophysiological studies demonstrated no peripheral neuropa-thy. She was treated with aggressive blood pressure control and physiotherapy. Oral clonazepam (0.25mg twice daily) adequately controlled the restless leg movements and improved her sleep qual-ity. Her abnormal leg movements abated after 2-weeks. Power in her extremities improved gradually and she recovered completely within a month. She denied any abnormal leg movements during past 1-year. Conclusion- We believe that RLS in our patient were related to hematoma-induced displacement of fibers connecting subcortical centers rather than a structural parenchymal damage. RLS may be seen in patients after subcortical intracerebral hemorrhage might have a much shorter course and better outcome as compared to the patients who develop RLS after ischemic stroke.
Karger_ESC London_2013
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