Right Temporal Variant Frontotemporal Dementia Misdiagnosed as Schizophrenia

2019 ◽  
Vol 15 (3) ◽  
pp. 223-227
Author(s):  
Mujeeb U. Shad ◽  
Lindsay Howard ◽  
Kristopher Thomas ◽  
Vimal M. Aga
Keyword(s):  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Neuropsychological Testing ◽  
White Male ◽  
Clinical History ◽  
Final Diagnosis ◽  
Interesting Case ◽  
Behavioral Impairment ◽  
Detailed Clinical History

Background: Schizophrenia-like presentations of frontotemporal dementia (FTD) are well documented in medical literature, especially during the initial stage of the illness. We present an interesting case of middle-aged white male, who was initially misdiagnosed with major depression at age 50 and then with schizophrenia due to florid psychosis typically seen in Mild Behavioral Impairment (MBI). It was not until over 4-years that a detailed clinical history along with specific investigations confirmed the diagnosis of right temporal variant frontotemporal dementia (rtv-FTD). Methods: The unusual presentation of this case warranted 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (FDG-PET) and comprehensive neuropsychological testing to estblish a final diagnosis. Results: The results from neuroimaging and neuropsychological testing supported a diagnosis of rtv-FTD without any evidence for Alzheimer’s dementia. Conclusion: This case illustrates that late-onset atypical psychiatric symptoms should be evaluated for neurocognitive disorders, and the evaluation should include neuroimaging. It is preferable that the neuroimaging findings be personally interpreted by the provider, who therefore needs to be skilled in interpreting neuroimaging studies.

Treatment-Refractory Schizoaffective Disorder in a Patient with Dyke-Davidoff-Masson Syndrome

CNS Spectrums ◽  
2009 ◽  
Vol 14 (1) ◽  
pp. 36-40 ◽  
Author(s):  
Benedikt Amann ◽  
Celia García de la Iglesia ◽  
Peter McKenna ◽  
Edith Pomarol-Clotet ◽  
Marisa Sanchez-Guerra ◽  
...  
Keyword(s):  
Schizoaffective Disorder ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Stressful Life Event ◽  
Facial Asymmetry ◽  
Clinical History ◽  
Cerebral Hemiatrophy ◽  
First Case ◽  
Perinatally Acquired

ABSTRACTDyke-Davidoff-Masson syndrome, or cerebral hemiatrophy, is a pre- or perinatally acquired entity characterized by predominantly neurologic symptoms, such as seizures, facial asymmetry, contralateral hemiplegia, and mental retardation. Psychiatric symptoms are rarely reported. We report the first case of left cerebral hemiatrophy and a late onset of treatment-resistant schizoaffective disorder after a stressful life event. The patient finally responded well to clozapine. The clinical history and results from structural neuroimaging are highlighted to discuss the possible developmental bias for psychotic disorders.

scholarly journals A study of clinicopathologic spectrum of vesicobullous disorders

2017 ◽  
Vol 3 (3) ◽  
pp. 355
Author(s):  
Heena Mittal ◽  
Sukhjot Kaur ◽  
Bhavna Garg ◽  
Neena Sood ◽  
Sunil Kumar Gupta ◽  
...  
Keyword(s):  
Pemphigus Vulgaris ◽  
Clinical History ◽  
Final Diagnosis ◽  
Stevens Johnson Syndrome ◽  
Direct Immunofluorescence ◽  
Diagnostic Dilemma ◽  
Dermoepidermal Junction ◽  
Female Ratio ◽  
Male Female Ratio ◽  
Detailed Clinical History

<p class="abstract"><strong>Background:</strong> <span lang="EN-IN">Blistering diseases are alarming skin conditions. Autoimmune blistering diseases are a group of bullous disorders characterized by pathogenic antibodies directed at the target antigens in the epidermis or dermoepidermal junction.</span><span lang="EN-IN">The objectives were to study the spectrum of histopathological changes by light microscopy, to evaluate the pattern of direct immunofluorescence (DIF) and to correlate clinical, histopathological features and DIF findings of vesiculobullous lesions of the skin or/and mucosa.</span></p><p class="abstract"><strong>Methods:</strong> <span lang="EN-IN">The present study was carried out on 110 skin and/or mucosal biopsies with vesicobullous disorders from July 2013 to June 2016. Detailed clinical history, morphology of lesions, site of involvement and other findings were recorded as per proforma.<strong> </strong>These cases were analysed clinically, histopathologically and on immunofluorescence</span>.<strong></strong></p><p class="abstract"><strong>Results:</strong> <span lang="EN-IN">Majority of the patients presented in the age group of 41-50 years (30.9%). The male: female ratio was 1:1.15. Pemphigus vulgaris was the most common vesiculobullous disorder constituting 48.2%, followed by Bullous Pemphigoid constituting 27.3%. Dermatitis herpetiformis constituted 8.3%; Pemphigus foliaceous 3.6%, varicella and Stevens Johnson Syndrome both were observed in 2.7% each. DIF was performed in 81 cases out of which only 72 cases (92.6%) showed positivity. </span></p><p class="abstract"><strong>Conclusions:</strong> <span lang="EN-IN">DIF is a sensitive tool for distinguishing immune mediated bullous diseases from other vesiculobullous disorders especially in cases which pose a diagnostic dilemma both clinically and histologically. The final diagnosis depends on correlation of clinical, histopathological and immunoflourescence findings.</span></p><p class="abstract"> </p>

Right frontal meningioma presenting as delusional parasitosis

2021 ◽  
Vol 14 (10) ◽  
pp. e245249
Author(s):  
Kavitha Konnakkaparambil Ramakrishnan ◽  
Lavanya Mohan ◽  
Jwala Jasha Jacob ◽  
Roopasree Gopinath
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Old Age ◽  
Psychiatric Symptoms ◽  
Clinical History ◽  
Midline Shift ◽  
Delusional Parasitosis ◽  
Central Nervous System Tumours ◽  
Detailed Clinical History

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.

Clinical overlap between behavioral variant of frontotemporal dementia and bipolar disorder: A case report

2016 ◽  
Vol 33 (S1) ◽  
pp. S335-S336 ◽  
Author(s):  
P. Oliveira ◽  
C. Roque ◽  
V. Santos ◽  
N. Madeira
Keyword(s):  
Bipolar Disorder ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Single Photon ◽  
Photon Emission ◽  
Interpersonal Behavior ◽  
Psychotic Symptoms ◽  
Emission Computed Tomography ◽  
Global Pattern

The behavioral variant of frontotemporal dementia (FTD) often begins with psychiatric symptoms, including changes in personal conduct and/or interpersonal behavior. Prior to developing cognitive impairment, differentiating FTD from primary psychiatric disorders might be challenging.This work presents a case of a manic episode with psychotic features in a 61-year-old man, whom personality changes and daily life difficulties arouse and persist after optimal management of the active manic and psychotic symptoms. Neuropsychological assessment detailed severe deficits among visuospatial and planning performances. Structural neuroimaging (CT-scan) primary revealed a global pattern of brain volume reduction. Severe perfusion deficits on frontal and both parietal lobes were shown on 99mTc-HMPAO single-photon emission computed tomography (SPECT). The hypothesis of probable FTD (behavioral variant) was established.The present case highlights how putative atypical and late-onset forms of bipolar disorder (BD) might instead progress to FTD. Several links are being advanced between the BD and FTD, for instance the close involvement of the C9ORF72 gene in a group of BD patients which progresses to dementia. These relations have actually been on focus recently. The field is however still relatively unexplored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cognitive Function and Psychiatric Symptoms in Early- and Late-Onset Frontotemporal Dementia

2008 ◽  
Vol 25 (5) ◽  
pp. 439-444 ◽  
Author(s):  
Shunichiro Shinagawa ◽  
Yasutaka Toyota ◽  
Tomohisa Ishikawa ◽  
Ryuji Fukuhara ◽  
Kazuhiko Hokoishi ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset

Kraepelin's ghost: Late onset schizophrenia, dementia (non)praecox, or paraphrenia? (case report)

2016 ◽  
Vol 33 (S1) ◽  
pp. S535-S535 ◽  
Author(s):  
V. Vukovic ◽  
S. Nikolić Lalić ◽  
T. Voskresenski ◽  
S. Jokić
Keyword(s):  
Case Report ◽  
Frontotemporal Dementia ◽  
Psychiatric Symptoms ◽  
Late Onset ◽  
Thought Disorder ◽  
Psychotic Symptoms ◽  
Causative Role ◽  
Visual Hallucinations ◽  
Formal Thought Disorder ◽  
Adequate Treatment

IntroductionIt is difficult to establish whether a patient has late onset schizophrenia or frontotemporal dementia. The object of the following case report is to point out the difficulty of making a differential diagnosis between these two entities.Case summaryA 49-year-old female patient was admitted to our hospital after presenting with auditory and visual hallucinations, formal thought disorder, persecutory delusions, ideas of reference, insomnia. Memory, executive function and attentional tasks were severely compromised. Computerized tomography showed incipient frontal lobe atrophy. There were no significant abnormalities found in blood and urine samples or physical and neurological examinations. After showing no response to olanzapine, and extrapyramidal side effects to fluphenazine, risperidone was initiated which subsequently led to complete withdrawal of positive symptoms.DiscussionPatients presenting with psychotic symptoms after the age of 40 presented a diagnostic quandary, as they were less likely to present with negative symptoms, formal thought disorder or affective blunting, and more likely to have systematised delusions and visual hallucinations. Frontotemporal dementia is a disorder that can present itself with cognitive decline and a large range of psychiatric symptoms. The risk of late onset schizophrenia is greater in women, possibly implicating a causative role of female sex hormones. Atypical antipsychotics risperidone and olanzapine seem to be an adequate treatment.ConclusionSchizophrenia is a heterogeneous disease with a large variety of clinical manifestations. Special care should be given to patients with age over 40, including neurocognitive assessment, laboratory and hormone tests, and a long-term follow-up.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Shape Profile of Corpus Callosum As a Signature to Phenotype Different Dementia

2020 ◽  
Author(s):  
Sandhya Mangalore ◽  
Shiva Shanker Reddy Mukku ◽  
Sriharish Vankayalapati ◽  
Palanimuthu Thangaraju Sivakumar ◽  
Mathew Varghese
Keyword(s):  
Corpus Callosum ◽  
Frontotemporal Dementia ◽  
Corticobasal Degeneration ◽  
Lewy Body Dementia ◽  
Clinical History ◽  
The Body ◽  
Cortical Atrophy ◽  
Alzheimer Dementia ◽  
Geriatric Clinic ◽  
Cortical Regions

Abstract Background Phenotyping dementia is always a complex task for a clinician. There is a need for more practical biomarkers to aid clinicians. Objective The aim of the study is to investigate the shape profile of corpus callosum (CC) in different phenotypes of dementia. Materials and Methods Our study included patients who underwent neuroimaging in our facility as a part of clinical evaluation for dementia referred from Geriatric Clinic (2017–2018). We have analyzed the shape of CC and interpreted the finding using a seven-segment division. Results The sample included MPRAGE images of Alzheimer’ dementia (AD) (n = 24), posterior cortical atrophy- Alzheimer’ dementia (PCA-AD) (n = 7), behavioral variant of frontotemporal dementia (Bv-FTD) (n = 17), semantic variant frontotemporal dementia (Sv-FTD) (n = 11), progressive nonfluent aphasia (PNFA) (n = 4), Parkinson’s disease dementia (PDD) (n = 5), diffuse Lewy body dementia (n = 7), progressive supranuclear palsy (PSP) (n = 3), and corticobasal degeneration (CBD) (n = 3). We found in posterior dementias such as AD and PCA-AD that there was predominant atrophy of splenium of CC. In Bv-FTD, the genu and anterior half of the body of CC was atrophied, whereas in PNFA, PSP, PDD, and CBD there was atrophy of the body of CC giving a dumbbell like profile. Conclusion Our study findings were in agreement with the anatomical cortical regions involved in different phenotypes of dementia. Our preliminary study highlighted potential usefulness of CC in the clinical setting for phenotyping dementia in addition to clinical history and robust biomarkers.

Sexual Dysfunction in Men Receiving Methadone Maintenance Treatment: Clinical History and Psychobiological Correlates

2015 ◽  
Vol 22 (3) ◽  
pp. 163-175 ◽  
Author(s):  
Gilberto Gerra ◽  
Matteo Manfredini ◽  
Lorenzo Somaini ◽  
Icro Maremmani ◽  
Claudio Leonardi ◽  
...  
Keyword(s):  
Sexual Dysfunction ◽  
Maintenance Treatment ◽  
Methadone Maintenance ◽  
Psychiatric Symptoms ◽  
Clinical History ◽  
Hormonal Changes ◽  
Opioid Agonist ◽  
Healthy Control ◽  
Methadone Patients

Abstract: A variety of studies evidenced a relationship between drug use disorders and sexual dysfunction. In particular, heroin and opioid agonist medications to treat heroin dependence have been found to be associated with erectile dysfunction and reduced libido. Controversial findings also indicate the possibility of factors other than the pharmacological effects of opioid drugs concurring to sexual dysfunction. With the present study, we investigated the link between sexual dysfunction and long-term exposure to opioid receptor stimulation (heroin dependence, methadone maintenance treatment, methadone dosage), the potentially related hormonal changes reflecting hypothalamus-pituitary-gonadal axis function and prolactin (PRL) pituitary release, the role of adverse childhood experiences in the clinical history and the concomitant symptoms of comorbid mental health disorders in contributing to sexual problems. Forty male patients participating in a long-term methadone treatment program were included in the present study and compared with 40 healthy control subjects who never used drugs nor abused alcohol. All patients and controls were submitted to the Arizona Sexual Experiences Scale (ASEX), Child Experiences of Care and Abuse-Questionnaire (CECA-Q) and the Symptom Check List-90 Scale. A blood sample for testosterone and PRL assays was collected. Methadone dosages were recorded among heroin-dependent patients on maintenance treatment. Methadone patients scored significantly higher than controls on the 5-item rating ASEX scale, on CECA-Q and on Symptoms Check List 90 (SCL 90) scale. Testosterone plasma levels were significantly lower and PRL levels significantly higher in methadone patients with respect to the healthy control group. ASEX scores reflecting sexual dysfunction were directly and significantly correlated with CECA-Q neglect scores and SCL 90 psychiatric symptoms total score. The linear regression model, when applied only to addicted patients, showed that methadone dosages were not significantly correlated with sexual dysfunction scores except for ‘erectile dysfunction', for which an inverse association was evidenced. Testosterone values showed a significant inverse correlation with ASEX sexual dysfunction scores, CECA-Q neglect scores and psychiatric symptom at SCL 90 among methadone patients. PRL levels were directly and significantly correlated with sexual dysfunction scores, psychiatric symptoms at SCL 90 and CECA-Q neglect scores. Both testosterone and PRL did not correlate with methadone dosages. The present findings appear to support the view of childhood adversities and comorbid psychiatric symptoms contributing to sexual dysfunction and related hormonal changes among methadone patients, challenging the assumption that attributes sexual problems entirely to the direct pharmacological effects of opioid agonist medications.

scholarly journals Diffuse Bullous Eruptions in an Elderly Woman: Late-Onset Bullous Systemic Lupus Erythematosus

2016 ◽  
Vol 8 (3) ◽  
pp. 278-282 ◽  
Author(s):  
Prajwal Boddu ◽  
Mojtaba Nadiri ◽  
Owais Malik
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Late Onset ◽  
Clinical History ◽  
The Elderly ◽  
Direct Immunofluorescence ◽  
Systemic Lupus ◽  
Diverse Range ◽  
American College Of Rheumatology ◽  
Type Vii Collagen

Vesiculobullous eruptions in the elderly represent a diverse range of varying pathophysiologies and can present a significant clinical dilemma to the diagnostician. Diagnosis requires a careful review of clinical history, attention to detail on physical and histomorphological examination, and appropriate immunofluorescence testing. We describe the case of a 73-year-old female who presented to our hospital with a painful blistering skin rash developed over 2 days. Examination of the skin was remarkable for numerous flaccid hemorrhagic bullae on a normal-appearing nonerythematous skin involving both the upper and lower extremities. Histopathology of the biopsy lesion showed interface change at the epidermo-dermal region with subepidermal blister formation, mild dermal fibrosis, and sparse interstitial neutrophilic infiltrate. Immunohistological analysis was significant for positive IgG basement membrane zone antibodies with a dermal pattern of localization on direct immunofluorescence and positive IgG antinuclear antibodies on indirect immunofluorescence. Evidence of antibodies to type VII collagen suggested the diagnosis of epidermolysis bullosa acquisita versus bullous systemic lupus erythematosus (BSLE). A diagnosis of BSLE was made based on positive American College of Rheumatology criteria, acquired vesiculo-bullous eruptions with compatible histopathological and immunofluorescence findings. This case illustrates one of many difficulties a physician encounters while arriving at a diagnosis from a myriad of immunobullous dermatoses. Also, it is important for internists and dermatologists alike to be aware of and differentiate this uncommon and nonspecific cutaneous SLE manifestation from a myriad of disorders presenting with vesiculobullous skin eruptions in the elderly.

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