Kar Sujita Kumar, Kumar Deepak, Singh Paramjeet, Upadhyay Pankaj Kumar
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
Department of Psychiatry, Institute of Human Behavior and Allied Sciences (IHBAS), Delhi, India.
Indian J Psychol Med. 2015 Apr-Jun;37(2):239-42. doi: 10.4103/0253-7176.155656.
The clinical manifestation of chronic subdural hematoma is not limited to neurological deficits or cognitive impairment. It may present with behavioral abnormalities. When the behavioral abnormalities present without obvious neurological deficits and in the absence of trauma, it leads to misdiagnosis. A trivial trauma may cause intracranial bleed that is either missed or ignored in the clinical history. This case report highlights the clinical picture of a homeless patient who presented with withdrawn and disorganized behavior, apathy and poverty of speech in the absence of any neurological deficit. His clinical presentation led to a possibility of psychosis and he was started on antipsychotics. He had developed extrapyramidal side effects in low dose of antipsychotic without any clinical benefit in his clinical picture. Neuroimaging done to rule out any possible organicity-revealed bilateral subdural hematoma, which was later evacuated by neurosurgical intervention in multiple settings and the patient had improved. This case report unfolds the mystery behind the psychotic presentation in a homeless adult.
慢性硬膜下血肿的临床表现不仅限于神经功能缺损或认知障碍。它可能表现为行为异常。当行为异常在无明显神经功能缺损且无外伤的情况下出现时，容易导致误诊。轻微外伤可能导致颅内出血，而这在临床病史中可能被遗漏或忽视。本病例报告重点介绍了一名无家可归患者的临床表现，该患者在没有任何神经功能缺损的情况下，表现出退缩、行为紊乱、冷漠和言语贫乏。他的临床表现导致了患精神病的可能性，于是开始给他使用抗精神病药物。他在低剂量抗精神病药物治疗下出现了锥体外系副作用，但临床症状并未得到任何改善。为排除任何可能的器质性病变而进行的神经影像学检查显示双侧硬膜下血肿，随后在多处进行了神经外科手术清除血肿，患者病情有所改善。本病例报告揭示了一名无家可归成年人出现精神病表现背后的谜团。
