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J Clin Neurosci. 2018 Jan;47:154-156. doi: 10.1016/j.jocn.2017.10.051. Epub 2017 Nov 4.

Dramatic psychiatric and behavioral symptoms following a subthalamic lesion.

Author information

1
Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
2
Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China.
3
Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea.
4
Department of Neurology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea. Electronic address: brain@snu.ac.kr.

Abstract

Neuropsychiatric symptoms have been well documented after subthalamic nucleus deep brain stimulation (STN-DBS), but those following a subthalamic lesion have been rarely reported. Herein, we present a 43-year-old woman with sudden-onset dramatic psychiatric and behavioral symptoms with hemiballism. Brain magnetic resonance imaging (MRI) with fluid attenuated inversion recovery (FLAIR) sequence during the acute phase demonstrated extensive hyperintensity in the left STN and adjacent regions. Contrast-enhanced MRI showed no abnormal areas of enhancement. Magnetic resonance venography (MRV) was normal. Routine blood and cerebrospinal fluid (CSF) tests were not remarkable. Autoimmune antibodies showed no significant results. A gradual recovery of both psychiatric and behavioral symptoms and hemiballism was observed with steroid and symptomatic treatment. Our case is unique in dramatic neuropsychiatric symptoms following a subthalamic lesion. We would like to point out that severe neuropsychiatric symptoms can occur in the patients with subthalamic lesions, and can be a troubling feature in their management.

KEYWORDS:

Limbic circuitry; Neuropsychiatric symptoms; Subthalamic lesion

PMID:
29113860
DOI:
10.1016/j.jocn.2017.10.051
[Indexed for MEDLINE]

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