Nishiyori Yasushi, Nishida Masaki, Shioda Katsutoshi, Suda Shiro, Kato Satoshi
Department of Psychiatry, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke, Tochigi 329-0498, Japan.
J Med Case Rep. 2014 Jun 23;8:219. doi: 10.1186/1752-1947-8-219.
In our case report we describe the case of a patient who experienced a stroke in her left hippocampus that was found following an attempted suicide via glyphosate overdose. To the best of our knowledge this is the first case report to describe a hippocampal infarction associated with a drug overdose.
A 64-year-old Japanese woman was brought to our emergency department after ingestion of an unknown dose of glyphosate surfactant herbicide in order to attempt suicide. On admission, she was assumed to be presenting with depression or psychiatric illness, however, sudden-onset memory deficit became apparent. The patient manifested delirium, confusion, and severe anxiety. In addition, short-term memory loss was prominent, with the patient forgetting her attempted suicide. Following an array of standard tests and a brain computed tomography scan (which only showed an old infraction), we performed a magnetic resonance imaging scan and neuropsychological evaluations. The brain magnetic resonance image revealed a small high-intensity lesion in the dorsal part of the left hippocampal body, and memory tests demonstrated severe short-term recall deficits. We diagnosed her with a left hippocampal infarction and administered a course of 75mg of clopidogrel. She gradually became less confused over the course of a week, and a follow-up memory test revealed partial improvement in some domains. No abnormalities were found on a follow-up brain scan. However, despite rehabilitation, memory impairments remain.
It is important to note that had the symptom of short-term memory been absent or less severe, she might have been misdiagnosed with depression or another psychiatric illness. Although a computed tomography scan failed to detect hippocampal lesions, a diffusion-weighted magnetic resonance imaging scan clearly revealed a lesion within the left hippocampus. Therefore, in addition to assessments focusing on psychiatric illnesses that might be the root cause of an attempted suicide, organic factors should be considered along with radiological examination and precise memory assessments for diagnosing similar cases.
在我们的病例报告中，我们描述了一名患者的病例，该患者在过量服用草甘膦企图自杀后，被发现左侧海马体发生中风。据我们所知，这是第一例描述与药物过量相关的海马体梗死的病例报告。
一名64岁的日本女性在摄入未知剂量的草甘膦表面活性剂除草剂企图自杀后，被送往我们的急诊科。入院时，她被认为患有抑郁症或精神疾病，然而，突然出现的记忆缺陷变得明显。患者表现出谵妄、意识模糊和严重焦虑。此外，短期记忆丧失很突出，患者忘记了自己企图自杀的事情。在进行了一系列标准检查和脑部计算机断层扫描（仅显示陈旧性梗死）后，我们进行了磁共振成像扫描和神经心理学评估。脑部磁共振图像显示左侧海马体背侧有一个小的高强度病变，记忆测试显示严重的短期回忆缺陷。我们诊断她为左侧海马体梗死，并给予75毫克氯吡格雷的疗程。在一周的时间里，她逐渐变得不那么困惑，后续的记忆测试显示在某些领域有部分改善。随访脑部扫描未发现异常。然而，尽管进行了康复治疗，记忆障碍仍然存在。
需要注意的是，如果没有短期记忆症状或症状较轻，她可能会被误诊为抑郁症或其他精神疾病。尽管计算机断层扫描未能检测到海马体病变，但扩散加权磁共振成像扫描清楚地显示了左侧海马体内的病变。因此，除了关注可能是自杀未遂根源的精神疾病评估外，在诊断类似病例时，还应考虑有机因素，并结合放射学检查和精确的记忆评估。
