Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report

Abstract Background Dyke–Davidoff–Masson syndrome is an uncommon constellation of radiological and clinical findings. Few reports describe co-occurring psychiatric manifestations. Systemic lupus erythematosus is a systemic disease with vascular, neurologic, and psychiatric involvement. To the best o...

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Main Authors: José Sordia-Ramírez, Adrián Infante-Valenzuela, Iván de Jesús Hernández-Galarza, Antonio Costilla-Esquivel
Format: Article
Language:English
Published: BMC 2019-04-01
Series:Journal of Medical Case Reports
Subjects:
Online Access:http://link.springer.com/article/10.1186/s13256-019-2039-2
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spelling doaj-594e27b69c2f4bf2a88604e3672ff4f32020-11-25T02:38:56ZengBMCJournal of Medical Case Reports1752-19472019-04-011311610.1186/s13256-019-2039-2Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case reportJosé Sordia-Ramírez0Adrián Infante-Valenzuela1Iván de Jesús Hernández-Galarza2Antonio Costilla-Esquivel3Department of Psychiatry, University Hospital “Dr. José E. González”, Autonomous University of Nuevo LeónNeurology Service, Internal Medicine Department, University Hospital “Dr. José E. González”, Autonomous University of Nuevo LeónRheumatology Service, Internal Medicine Department, University Hospital “Dr. José E. González”, Autonomous University of Nuevo LeónDepartment of Psychiatry, University Hospital “Dr. José E. González”, Autonomous University of Nuevo LeónAbstract Background Dyke–Davidoff–Masson syndrome is an uncommon constellation of radiological and clinical findings. Few reports describe co-occurring psychiatric manifestations. Systemic lupus erythematosus is a systemic disease with vascular, neurologic, and psychiatric involvement. To the best of our knowledge, no case reports have been made associating these entities. Case presentation We present the case of a 21-year-old Mexican mestizo woman with a history of systemic lupus erythematosus diagnosed at 4 years of age, who developed focal impaired awareness seizures when she was 8-years old, which became treatment-resistant at age 15. Two years prior to our evaluation, she developed deep vein thrombosis; clinical and laboratory criteria were met to diagnose secondary antiphospholipid syndrome. After being treated with anticonvulsants, glucocorticoids, and immunosuppressants with only a partial response, she developed a severe major depressive episode 1 year prior to our assessment, including two suicide attempts. She was referred to the out-patient clinic of our department for evaluation; intellectual disability, depressive symptoms, and behavioral symptoms were documented. Imaging studies revealed structural abnormalities in the left cerebral hemisphere: cortical atrophy, enlargement of sulci and cisternal spaces, and hyperpneumatization of the frontal sinus. Treatment with an antidepressant was initiated and maintained for 1 year, added to anticonvulsants and immunosuppressants. Depressive and behavioral symptoms diminished and no suicidal ideation has been noted at follow-up. Conclusions Dyke–Davidoff–Masson syndrome was diagnosed, accompanied by clinical symptoms previously reported as epilepsy and intellectual disability. This case report illustrates the complexity of syndrome presentation in an adult female, constituting a diagnostic and therapeutic challenge. This constellation of symptoms and structural brain abnormalities should be kept in mind in patients with neuropsychiatric manifestations and systemic diseases with central nervous system involvement, especially when diagnosed at a young age.http://link.springer.com/article/10.1186/s13256-019-2039-2Neuropsychiatric symptomsDyke–Davidoff–Masson syndromeSystemic lupus erythematosusDepressionAntiphospholipid syndrome
collection DOAJ
language English
format Article
sources DOAJ
author José Sordia-Ramírez
Adrián Infante-Valenzuela
Iván de Jesús Hernández-Galarza
Antonio Costilla-Esquivel
spellingShingle José Sordia-Ramírez
Adrián Infante-Valenzuela
Iván de Jesús Hernández-Galarza
Antonio Costilla-Esquivel
Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report
Journal of Medical Case Reports
Neuropsychiatric symptoms
Dyke–Davidoff–Masson syndrome
Systemic lupus erythematosus
Depression
Antiphospholipid syndrome
author_facet José Sordia-Ramírez
Adrián Infante-Valenzuela
Iván de Jesús Hernández-Galarza
Antonio Costilla-Esquivel
author_sort José Sordia-Ramírez
title Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report
title_short Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report
title_full Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report
title_fullStr Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report
title_full_unstemmed Neuropsychiatric symptoms in a patient with Dyke–Davidoff–Masson syndrome and systemic lupus erythematosus: a case report
title_sort neuropsychiatric symptoms in a patient with dyke–davidoff–masson syndrome and systemic lupus erythematosus: a case report
publisher BMC
series Journal of Medical Case Reports
issn 1752-1947
publishDate 2019-04-01
description Abstract Background Dyke–Davidoff–Masson syndrome is an uncommon constellation of radiological and clinical findings. Few reports describe co-occurring psychiatric manifestations. Systemic lupus erythematosus is a systemic disease with vascular, neurologic, and psychiatric involvement. To the best of our knowledge, no case reports have been made associating these entities. Case presentation We present the case of a 21-year-old Mexican mestizo woman with a history of systemic lupus erythematosus diagnosed at 4 years of age, who developed focal impaired awareness seizures when she was 8-years old, which became treatment-resistant at age 15. Two years prior to our evaluation, she developed deep vein thrombosis; clinical and laboratory criteria were met to diagnose secondary antiphospholipid syndrome. After being treated with anticonvulsants, glucocorticoids, and immunosuppressants with only a partial response, she developed a severe major depressive episode 1 year prior to our assessment, including two suicide attempts. She was referred to the out-patient clinic of our department for evaluation; intellectual disability, depressive symptoms, and behavioral symptoms were documented. Imaging studies revealed structural abnormalities in the left cerebral hemisphere: cortical atrophy, enlargement of sulci and cisternal spaces, and hyperpneumatization of the frontal sinus. Treatment with an antidepressant was initiated and maintained for 1 year, added to anticonvulsants and immunosuppressants. Depressive and behavioral symptoms diminished and no suicidal ideation has been noted at follow-up. Conclusions Dyke–Davidoff–Masson syndrome was diagnosed, accompanied by clinical symptoms previously reported as epilepsy and intellectual disability. This case report illustrates the complexity of syndrome presentation in an adult female, constituting a diagnostic and therapeutic challenge. This constellation of symptoms and structural brain abnormalities should be kept in mind in patients with neuropsychiatric manifestations and systemic diseases with central nervous system involvement, especially when diagnosed at a young age.
topic Neuropsychiatric symptoms
Dyke–Davidoff–Masson syndrome
Systemic lupus erythematosus
Depression
Antiphospholipid syndrome
url http://link.springer.com/article/10.1186/s13256-019-2039-2
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