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A manic episode with psychotic features improved by methylprednisolone in a patient with multiple sclerosis
Sevan Hotier1, David Maltete2, Bertrand Bourre2
1Department of Psychiatry, Rouen University, France.
Abstract:
Several studies have reported a higher prevalence of unipolar depression and bipolar disorder among patients with multiple sclerosis (MS). However, only a few studies have reported manic episodes concomitant with new lesions enhanced by gadolinium on brain magnetic resonance imaging (MRI). Here we report the case of a 47-year-old woman suffering from MS admitted for a manic episode with psychotic features. Brain MRI revealed three new T2 lesions enhanced by gadolinium located in the corpus callosum and in ventromedial prefrontal regions. She rapidly recovered with intravenous methylprednisolone in combination with risperidone. In conclusion, in this patient, the fact that gadolinium-enhancing lesion coincided with new symptoms which responded quickly to corticosteroids suggests that the manic episode was an acute manifestation of MS.
Insights
Multiple sclerosis (MS) can manifest with psychiatric symptoms like mania. In a case study, new MS lesions on MRI correlated with a manic episode that responded to treatment, suggesting a direct link.
Area of Science:
- Neurology
- Psychiatry
- Neuroimmunology
Background:
- Multiple sclerosis (MS) is frequently associated with mood disorders, including depression and bipolar disorder.
- Manic episodes are less commonly reported in MS patients, and their direct correlation with disease activity is not well-established.
Observation:
- A 47-year-old woman with MS presented with a manic episode featuring psychotic symptoms.
- Brain magnetic resonance imaging (MRI) revealed three new gadolinium-enhancing T2 lesions in the corpus callosum and ventromedial prefrontal cortex.
Findings:
- The patient experienced rapid symptom improvement with intravenous methylprednisolone and risperidone.
- The temporal and anatomical correlation between new MS lesions and the manic episode suggests a direct causal relationship.
Implications:
- This case highlights the potential for acute manic episodes to be a direct neurological manifestation of active MS.
- Early recognition and treatment of such episodes, potentially involving immunomodulatory therapy, may be crucial for patient recovery.
- Further research is warranted to understand the neurobiological mechanisms linking MS activity to manic symptoms.
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