Low-dose clozapine monotherapy for recurring episodes of depression, hypersomnia and behavioural disturbances: a case report

Havaki-Kontaxaki BJ, Ferentinos PP, Kontaxakis VP, Kontaxaki M-I V, Geronikola X, Armeniakos I, Papadimitriou GN. Low-dose clozapine monotherapy for recurring episodes of depression, hypersomnia and behavioural disturbances: a case report.Case Report: We present a 27-year-old woman who manifested recurrent episodes of hypersomnia, compulsive hyperphagia, hypersexuality, impulsive behaviours, irritability and depressive mood since the age of 13 after a viral febrile infection. She had 3–4 episodes/year lasting from a few days to 2–3 weeks which were managed with various psychotropics. During her last episode, she was admitted because of persistent behavioural disturbances. Brain 99m-Tc-ethyl cysteinate dimer single-photon emission computed tomography scans showed bilateral mesiotemporal and thalamic hypoperfusion, more significant in the right hemisphere. While hospitalised, she developed neuroleptic malignant syndrome following haloperidol administration. She was discharged on clozapine 100 mg/day. Over the following 30 months, she remained symptom free on clozapine 50–100 mg/day.Discussion: Differential diagnosis included either an atypical recurrent mood disorder with hypersomnia and behavioural disturbances or Kleine–Levin syndrome.Conclusion: Low-dose clozapine monotherapy may worth being further investigated for the management of recurring episodes of depression, hypersomnia and behavioural disturbances.

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Head-to-Head Comparison of Exercise–Redistribution–Reinjection Thallium Single-Photon Emission Computed Tomography and Low Dose Dobutamine Echocardiography for Prediction of Reversibility of Chronic Left Ventricular Ischemic Dysfunction

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(96)00167-2 ◽

1996 ◽

Vol 28 (2) ◽

pp. 432-442 ◽

Cited By ~ 11

Author(s):

J Vanoverschelde, MD

Keyword(s):

Computed Tomography ◽

Low Dose ◽

Single Photon ◽

Photon Emission ◽

Left Ventricular ◽

Emission Computed Tomography ◽

Single Photon Emission ◽

Emission Computed ◽

Single Photon Emission Computed ◽

Photon Emission Computed Tomography

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Shifting of global aphasia to Wernicke’s aphasia in a patient with intact motor function: a case report

BMC Neurology ◽

10.1186/s12883-021-02131-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ya-Chi Chuang ◽

Chuan-Ching Liu ◽

I-Ching Yu ◽

Yu-Lin Tsai ◽

Shin-Tsu Chang

Keyword(s):

Computed Tomography ◽

Right Hemisphere ◽

Single Photon ◽

Ct Perfusion ◽

Single Case ◽

Photon Emission ◽

Emission Computed Tomography ◽

Speech Fluency ◽

Language Functions ◽

The Right

Abstract Background Global aphasia without hemiparesis (GAWH) is a rare stroke syndrome characterized by the dissociation of motor and language functions. Here, we present a case of GAWH with the patient later regaining speech fluency. Case presentation A 73-year-old man was admitted to our emergency department immediately after an episode of syncope. On arrival, we noted his global aphasia but without any focal neurologic signs. Computed tomography (CT) perfusion scans showed a large hypodense region over his left perisylvian area. Under the impression of acute ischaemic stroke, he received recombinant tissue plasminogen activator (rtPA) injection and was treated as an inpatient. The patient was later discharged with GAWH status and received regular speech rehabilitation. After 14 months of rehabilitation, the patient gradually recovered his language expression ability. The degree of aphasia was evaluated with the Concise Chinese Aphasia Test (CCAT), and we obtained brain single photon emission computed tomography (SPECT) scans to assess cerebral blood flow. Conclusion A patient with severe impairments of Broca’s and Wernicke’s areas was able to talk fluently despite being unintelligible. SPECT revealed relative high level of radioactivity uptake in the right frontal lobe, suggesting the deficits in speech fluency could have been compensated by the right hemisphere. Although this is a single case demonstration, the results may strengthen the role of the right hemisphere in GAWH patients and suggests additional study that examines the possible benefits of stimulating activity at right homologous regions for recovering language function after global aphasia.

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Cerebral Hemispheric and Contralateral Cerebellar Hypoperfusion during a Transient Ischemic Attack

Journal of Cerebral Blood Flow & Metabolism ◽

10.1038/jcbfm.1987.95 ◽

1987 ◽

Vol 7 (4) ◽

pp. 507-509 ◽

Cited By ~ 23

Author(s):

Daniela Perani ◽

Paolo Gerundini ◽

Gian Luigi Lenzi

Keyword(s):

Single Photon ◽

Photon Emission ◽

Complete Recovery ◽

Emission Computed Tomography ◽

Left Middle Cerebral Artery ◽

Single Photon Emission Computed ◽

Ischemic Attack ◽

The Right ◽

Photon Emission Computed Tomography ◽

Left Middle

We studied a 79-year-old woman within 3 h of the onset of a motor aphasia and a right hemiparesis. Single photon emission computed tomography (SPECT) showed a 24% decrease in the perfusion of the left middle cerebral artery territory and a 16% reduction in the perfusion of the right cerebellum. A mild naming difficulty was the neurological deficit at the end of the SPECT examination, and complete recovery was achieved within 24 h. Repeated SPECT study 10 days later was normal. This is the first report of focal hemispheric and contralateral cerebellar hypoperfusion in transient cerebral ischemia.

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