Marijnissen Radboud M, Bakker Miranda, Stek Max L
De Gelderse Roos, afd. Ouderen, Arnhem, The Netherlands.
Ned Tijdschr Geneeskd. 2010;154:A1235.
A manic episode in old age presents a diagnostic challenge to the clinician due to the different symptomatology often difficult to distinguish from delirium, dementia, agitated depression and psychosis. To complicate matters further, a first episode of mania in later life is very often based on underlying physical and cerebral pathology ('secondary mania'). Many causes of 'secondary mania', including neurological, systemic or endocrine diseases, infections, intoxications, apnoea, post-thoracic surgery and vitamin B12 deficiency have been described to date, but there have been no reports on subdural haematomas in this context. However, the elderly are more prone to subdural haematomas following head trauma than younger patients. We present two case reports of older patients with a first manic episode in later life probably caused by subdural haematomas. A first episode of mania in later life always requires thorough assessment of the patient to determine physical and cerebral pathology.
老年期的躁狂发作给临床医生带来了诊断挑战，因为其症状表现各异，常常难以与谵妄、痴呆、激越性抑郁和精神病相区分。更复杂的是，晚年首次发作的躁狂症往往基于潜在的身体和脑部病变（“继发性躁狂症”）。迄今为止，已描述了许多“继发性躁狂症”的病因，包括神经、全身或内分泌疾病、感染、中毒、呼吸暂停、胸外科手术后情况以及维生素B12缺乏，但尚未有关于硬膜下血肿引发继发性躁狂症的报道。然而，老年人比年轻患者更容易在头部外伤后发生硬膜下血肿。我们报告两例老年患者的病例，其晚年首次出现躁狂发作可能是由硬膜下血肿引起的。晚年首次发作的躁狂症总是需要对患者进行全面评估，以确定身体和脑部病变情况。
