Mamtani Harkishan, Utagi Shridhar, Chaurasia Kavish K, Reddy Preethi Veerappa, Arasappa Rashmi, Prasad Chandrajit, Srinivas Dwarakanath, Rao Malla Bhaskara, Thippeswamy Harish
Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Indian J Psychiatry. 2024 Feb;66(2):208-212. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_417_23. Epub 2024 Feb 12.
Bell's mania is the co-occurrence of delirium and mania. We present two cases of Bell's mania in a neurosurgical setting. The first case is of a 52-year-old male who presented with holocranial headache, disorientation, and manic symptoms for five months. He was found to have suprasellar craniopharyngioma. He significantly improved with olanzapine, but re-emergence of mood symptoms was noted after surgery. The second case is of a 42-year-old male who presented with a 15-day history of seizures and disorientation. He was found to have a dural arteriovenous fistula. He developed Bell's mania in the post-procedural period, which improved with olanzapine. Compression of the hypothalamo-pituitary stalk in the first case and vascular and inflammatory changes in the second case could have led to Bell's mania. Atypical age of onset and presence of neurological symptoms in patients presenting with psychiatric symptoms should raise the suspicion of an underlying organicity. Atypical anti-psychotics can be a useful management strategy for Bell's mania.
贝尔氏躁狂症是谵妄和躁狂同时出现的情况。我们展示了两例神经外科环境下的贝尔氏躁狂症病例。第一例是一名52岁男性，出现全颅头痛、定向障碍和躁狂症状达五个月。他被发现患有鞍上颅咽管瘤。使用奥氮平后他有显著改善，但术后情绪症状再次出现。第二例是一名42岁男性，有15天的癫痫发作和定向障碍病史。他被发现患有硬脑膜动静脉瘘。他在术后出现贝尔氏躁狂症，使用奥氮平后病情改善。第一例中下丘脑 - 垂体柄受压以及第二例中的血管和炎症变化可能导致了贝尔氏躁狂症。出现精神症状的患者中，非典型的发病年龄和神经症状的存在应引起对潜在器质性病变的怀疑。非典型抗精神病药物可能是治疗贝尔氏躁狂症的一种有用的管理策略。
