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Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale.
Eur J Case Rep Intern Med 2019; 6(7):001120EJ

Abstract

Neurological and psychiatric diseases often present with overlapping features. Patients are sometimes seen by internal medicine, neurology and psychiatry clinicians and time can be important for determining whether a condition is organic or not. The authors present the case of a 31-year-old woman admitted to the emergency department with altered mental status and incomprehensible speech. She had a previous history of anxiety and smoking and was under therapy with benzodiazepines and combined hormonal contraceptives. After an acute neurological disorder was ruled out, the patient was transferred to the psychiatry department, where she was re-evaluated after 12 hours of observation and benzodiazepine washout. As speech impairment and confusion were still present, she was transferred to the Stroke Unit. A bilateral thalamic lesion containing a small focal haemorrhage and a moderate grade right-to-left shunt were identified. A patent foramen ovale was confirmed leading to the final diagnosis of acute ischaemic infarction secondary to a paradoxical embolism. Medical therapy was preferred over percutaneous closure. Risk factors were removed (smoking and hormonal contraceptives), and after the patient recovered completely acetylsalicylic acid 100 mg daily was initiated.

LEARNING POINTS

Psychiatric symptoms and medication often mask organic conditions, so observation and re-evaluation are key.There are new guidelines for the treatment of patent foramen ovale-related strokes, but not all patients fit the guidelines.A relationship between stroke in the young adult, smoking and hormonal contraceptives should always be considered.

Authors+Show Affiliations

Unidade Local Saude Alto Minho, EPE, Portugal.Unidade Local Saude Alto Minho, EPE, Portugal.Unidade Local Saude Alto Minho, EPE, Portugal.Centro Hospitalar de Lisboa Ocidental, EPE, Portugal.Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.Stroke Unit, Neurology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31410351

Citation

Barbosa, Manuel Martins, et al. "Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: a Cautionary Tale." European Journal of Case Reports in Internal Medicine, vol. 6, no. 7, 2019, p. 001120.
Barbosa MM, Araújo E, Pereira M, et al. Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale. Eur J Case Rep Intern Med. 2019;6(7):001120.
Barbosa, M. M., Araújo, E., Pereira, M., Costa, R. M., Ballvé, A., Rubiera, M., & Molina, C. A. (2019). Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale. European Journal of Case Reports in Internal Medicine, 6(7), p. 001120. doi:10.12890/2019_001120.
Barbosa MM, et al. Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: a Cautionary Tale. Eur J Case Rep Intern Med. 2019;6(7):001120. PubMed PMID: 31410351.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Psychiatric Symptoms and Benzodiazepine Use Mask a Patent Foramen Ovale-Related Stroke: A Cautionary Tale. AU - Barbosa,Manuel Martins, AU - Araújo,Elsa, AU - Pereira,Marta, AU - Costa,Rui Marques, AU - Ballvé,Alejandro, AU - Rubiera,Marta, AU - Molina,Carlos A, Y1 - 2019/07/05/ PY - 2019/04/14/received PY - 2019/05/08/accepted PY - 2019/8/15/entrez PY - 2019/8/15/pubmed PY - 2019/8/15/medline KW - PFO closure KW - PFO medical therapy KW - Psychiatric mimics KW - patent foramen ovale KW - stroke in a young adult SP - 001120 EP - 001120 JF - European journal of case reports in internal medicine JO - Eur J Case Rep Intern Med VL - 6 IS - 7 N2 - : Neurological and psychiatric diseases often present with overlapping features. Patients are sometimes seen by internal medicine, neurology and psychiatry clinicians and time can be important for determining whether a condition is organic or not. The authors present the case of a 31-year-old woman admitted to the emergency department with altered mental status and incomprehensible speech. She had a previous history of anxiety and smoking and was under therapy with benzodiazepines and combined hormonal contraceptives. After an acute neurological disorder was ruled out, the patient was transferred to the psychiatry department, where she was re-evaluated after 12 hours of observation and benzodiazepine washout. As speech impairment and confusion were still present, she was transferred to the Stroke Unit. A bilateral thalamic lesion containing a small focal haemorrhage and a moderate grade right-to-left shunt were identified. A patent foramen ovale was confirmed leading to the final diagnosis of acute ischaemic infarction secondary to a paradoxical embolism. Medical therapy was preferred over percutaneous closure. Risk factors were removed (smoking and hormonal contraceptives), and after the patient recovered completely acetylsalicylic acid 100 mg daily was initiated. LEARNING POINTS: Psychiatric symptoms and medication often mask organic conditions, so observation and re-evaluation are key.There are new guidelines for the treatment of patent foramen ovale-related strokes, but not all patients fit the guidelines.A relationship between stroke in the young adult, smoking and hormonal contraceptives should always be considered. SN - 2284-2594 UR - https://www.unboundmedicine.com/medline/citation/31410351/Psychiatric_Symptoms_and_Benzodiazepine_Use_Mask_a_Patent_Foramen_Ovale-Related_Stroke:_A_Cautionary_Tale L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/31410351/ DB - PRIME DP - Unbound Medicine ER -