Underlying cerebrovascular pathology causing secondary psychosis

Abstract

Case Background

Psychosis can be classified as primary if it is caused by a psychiatric disorder or secondary if it is due to a specific medical condition. Despite there being multiple identified causes of secondary psychosis, making such a diagnosis can prove challenging.

Case Details

This case report presents a 57-year-old male who was brought by ambulance to the emergency department following an intentional jump from a first story window due to visual and auditory hallucinations and persecutory paranoid delusions. MRI findings on admission were consistent with cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). The patient’s background included an ischaemic stroke with haemorrhagic transformation five years previously. He experienced psychotic symptoms during the immediate recovery period. Prior to this he had no psychiatric history.

Discussion

Post-stroke psychosis and the condition of CADASIL are both entities that are relatively rarely described in the literature. However, this may be due to missed diagnosis and therefore not reflective of true prevalence.

Conclusion

Identifying a cause-effect relationship and establishing a diagnosis of secondary psychosis can be confounded by many factors. Nevertheless, this patient’s case demonstrates the importance of considering an underlying cause, particularly when the presentation is atypical and there is a temporal relationship between the proposed medical condition and the symptoms of psychosis.

Patient Consent Obtained: Yes