Dual dilemma
We discussed two cases today.
Case#1:
61 yo F with HTN, DM brought in by daughter for acute onset of a single acute episode of visual hallucinations. She saw a girl (non existent) run across her living room and then saw lasagna (non existent) all over herself. Daughter was with her at this time and called 911. Medical and neurological problems were ruled out with MRI/MRA, labs, complete neurological exam.
On further asking she says that her visual acuity has declined over past few months. She had possibly Charles Bonnet syndrome. Charles Bonnet syndrome is a benign condition where patients with decreased visual acuity have vivid visual hallucinations as a release phenomenon. Reassurance and treatment of the underlying visual disorder is the treatment of this disorder.
Case#2:
32 yo M brought in by sister and mother for sitting in a water-filled bathtub for three whole days. He sat in the tub all dressed and did not eat/drink for the whole time but ketp reading the bible stating that “he had to save mankind by reading the bible”. When brought in to the ED, other than being agitated, hyper-religious and needing restraints, he also displayed autonomic instability. DDx included Neuroleptic Malignant Syndrome, acute psychosis, malignant catatonia, CNS/ systemic infectious process. He had elevated CK and leucocytosis with tachycardia, fever and was admitted to MICU for monitoring. Concluding diagnosis was malignant catatonia.