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Organic Depression and Terson's Syndrome in Adult Polycystic Kidney Disease: Case Report and Review of Literature.

Kulkarni RR, Addagadde PV - Indian J Psychol Med (2014)

Bottom Line: Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin.Terson's syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting.Autosomal dominant (adult) polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Sri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, Dharwad, Karnataka, India.

ABSTRACT
Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin. Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes that resemble primary depressions both clinically and therapeutically in about half of the patients following acute stroke. Terson's syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting. Autosomal dominant (adult) polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds. We report an unusual case of organic depression and Terson's syndrome in a 50-year-old female with polycystic kidney disease and hypertension, following anterior communicating artery aneurysmal subarachnoid bleed with bilateral subdural extension. Management included anti-hypertensives, antiepileptics, neodymium: YAG laser photocoagulation, and aneurysmal clipping.

No MeSH data available.


Related in: MedlinePlus

Ultrasonography of abdomen showing bilateral renal illdefined multiple (>6) cysts and calculi
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Figure 2: Ultrasonography of abdomen showing bilateral renal illdefined multiple (>6) cysts and calculi

Mentions: On admission, the Glasgow Coma Scale[7] score was E4V5M6 and Hunt — Hess scale[8] was grade-1, with blood pressure of 190/110 mm Hg. Neuromuscular and cardiovascular examination was normal. Mental status examination revealed depressed mood, apathy, negative cognitions, impaired judgment with preserved attention, orientation, memory, and intelligence, with grade-4 insight. Hamilton depression rating[9] (HAMD-17 item) score was 16 and the score on the mini-mental status examination[10] was 28/30. Ophthalmological evaluation revealed reduced visual acuity in the right eye (1/60) and normal left eye (6/6), bilaterally normal anterior segments, normal pupils (bilaterally 3 mm, round, regular, and reacting to both direct and consensual light reflexes), and normal intraocular pressures. Fundoscopy showed boat-shaped subhyaloid hemorrhage involving the posterior pole extending below the inferior arcade, with multiple hemorrhages seen around the normal optic disc in the right eye [Figure 1a] and normal left fundus [Figure 1b], with evidence of bilateral grade-1 hypertensive retinopathy [Figure 1]. Hematological and biochemical investigations revealed moderate normocytic and normochromic anemia (hemoglobin 8.7 g/dL), mild leukocytosis (12,240/mm3), raised serum creatinine (2.5 mg/dL) with normal blood urea (42 mg/dL), serum electrolytes, blood glucose, lipid, liver, and thyroid profiles. Ultrasonography (USG) of abdomen showed bilateral renal ill-defined multiple (>6) cysts and calculi [Figure 2]. Echocardiography revealed mitral valve prolapse along with trivial mitral and aortic regurgitation. Electrocardiograph and carotid Doppler studies were normal. Electroencephalography showed right frontal polyspikes and sharp waves with preserved alpha background activity suggestive of epileptogenic foci. Cranial magnetic resonance imaging (MRI) revealed minimal SAH in the anterior inter-hemispheric fissure and adjacent cortical sulci with edema in adjacent frontal lobes, and hyper-acute SDH in bilateral fronto-temporo-parietal regions along the cerebral convexities (5 mm), with no mass effect or midline shift [Figure 3a], confirming the diagnosis of TS. Cerebral angiography showed small bi-lobed aneurysm (6 × 6 × 4 mm) arising from the ACoA with the neck of aneurysm measuring 1.5 mm in medio-lateral direction [Figure 3b].


Organic Depression and Terson's Syndrome in Adult Polycystic Kidney Disease: Case Report and Review of Literature.

Kulkarni RR, Addagadde PV - Indian J Psychol Med (2014)

Ultrasonography of abdomen showing bilateral renal illdefined multiple (>6) cysts and calculi
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3959032&req=5

Figure 2: Ultrasonography of abdomen showing bilateral renal illdefined multiple (>6) cysts and calculi
Mentions: On admission, the Glasgow Coma Scale[7] score was E4V5M6 and Hunt — Hess scale[8] was grade-1, with blood pressure of 190/110 mm Hg. Neuromuscular and cardiovascular examination was normal. Mental status examination revealed depressed mood, apathy, negative cognitions, impaired judgment with preserved attention, orientation, memory, and intelligence, with grade-4 insight. Hamilton depression rating[9] (HAMD-17 item) score was 16 and the score on the mini-mental status examination[10] was 28/30. Ophthalmological evaluation revealed reduced visual acuity in the right eye (1/60) and normal left eye (6/6), bilaterally normal anterior segments, normal pupils (bilaterally 3 mm, round, regular, and reacting to both direct and consensual light reflexes), and normal intraocular pressures. Fundoscopy showed boat-shaped subhyaloid hemorrhage involving the posterior pole extending below the inferior arcade, with multiple hemorrhages seen around the normal optic disc in the right eye [Figure 1a] and normal left fundus [Figure 1b], with evidence of bilateral grade-1 hypertensive retinopathy [Figure 1]. Hematological and biochemical investigations revealed moderate normocytic and normochromic anemia (hemoglobin 8.7 g/dL), mild leukocytosis (12,240/mm3), raised serum creatinine (2.5 mg/dL) with normal blood urea (42 mg/dL), serum electrolytes, blood glucose, lipid, liver, and thyroid profiles. Ultrasonography (USG) of abdomen showed bilateral renal ill-defined multiple (>6) cysts and calculi [Figure 2]. Echocardiography revealed mitral valve prolapse along with trivial mitral and aortic regurgitation. Electrocardiograph and carotid Doppler studies were normal. Electroencephalography showed right frontal polyspikes and sharp waves with preserved alpha background activity suggestive of epileptogenic foci. Cranial magnetic resonance imaging (MRI) revealed minimal SAH in the anterior inter-hemispheric fissure and adjacent cortical sulci with edema in adjacent frontal lobes, and hyper-acute SDH in bilateral fronto-temporo-parietal regions along the cerebral convexities (5 mm), with no mass effect or midline shift [Figure 3a], confirming the diagnosis of TS. Cerebral angiography showed small bi-lobed aneurysm (6 × 6 × 4 mm) arising from the ACoA with the neck of aneurysm measuring 1.5 mm in medio-lateral direction [Figure 3b].

Bottom Line: Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin.Terson's syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting.Autosomal dominant (adult) polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Sri Dharmasthala Manjunatheshwara (SDM) College of Medical Sciences and Hospital, Dharwad, Karnataka, India.

ABSTRACT
Depressive symptoms are common in neurological diseases, at times posing dilemma in organic or functional origin. Cerebrovascular disease may predispose, precipitate, or perpetuate some geriatric depressive syndromes that resemble primary depressions both clinically and therapeutically in about half of the patients following acute stroke. Terson's syndrome is the direct occurrence of vitreous hemorrhage following subarachnoid/subdural hemorrhage, often overlooked in the acute setting. Autosomal dominant (adult) polycystic kidney disease may be associated with berry aneurysms and hypertension, and may lead to intracranial bleeds. We report an unusual case of organic depression and Terson's syndrome in a 50-year-old female with polycystic kidney disease and hypertension, following anterior communicating artery aneurysmal subarachnoid bleed with bilateral subdural extension. Management included anti-hypertensives, antiepileptics, neodymium: YAG laser photocoagulation, and aneurysmal clipping.

No MeSH data available.


Related in: MedlinePlus