Manic Patient with Meningioma Treated with Low dose Risperidone and Valproic Acid = 저용량 리스페리돈과 발프로에이트로 치료된 뇌수막종에 의한 조증

다국어 초록 (Multilingual Abstract)

We describe the case of a 73 year-old female patient, YSG, who initially presented with a manic episode without any previous psychiatric history and was later diagnosed as having a meningioma in the left frontal lobe. YSG's symptoms were characterized by hyperactivity, insomnia, aggressive behavior with an auditory hallucination. She showed no abnormal signs on a complete neurologic examination. A gadolinium-enhanced MRI study showed a huge, extra-axial mass with homogenous enhancement in the left high convexity of the frontal lobe. Her manic symptoms subsided after administration of risperidone 1mg and valproic acid 500mg daily, for three weeks without surgical resection of the tumor. These findings suggest that YSG's mania might have resulted from the left-sided frontal tumor, and that her symptoms were treated rapidly by small doses of risperidone combined with valproic acid. Medical staff who care for manic patients should be aware of this possibility of a organic lesion without evidence of neurologic disease.

참고문헌 (Reference)

1 "User’s guide, administration booklet, and scoresheetfor the Structured Clinical Interview for DSM-IVAxis I Disorders, clinician version." 62 : 126-129, 1998

2 "Tumors of the nervous system Harrison’s Principles of Internal Medicine.Harrison’s Principles of Internal Medicine." The McGraw-Hill Companies 2398-2409, 1998

3 "Three case reports of secondarymania:evidence supporting a right frontotemporal locus." 18 : 32-33, 2003

4 "Neuropsychiatric manifestations of righthemisphere lesions" 57 : 22-37, 1997

5 "Mental symptoms in cases oftumor of the frontal lobe" 986-1005, archivesneurologypsychiatry1935;33

6 "Mechanismsof mania after brain injury 12 case reports andreview of the literature" 87-100, jnervousmentaldisease1988;176

7 "Mania after brain injury" 652-659,

8 "Frontal lobe psychopathology: mania, depression,confabulation, catatonia, perseveration, obsessivecompulsions, and schizophrenia." 62 : 138-172, 1999

9 "Disinhibition syndromes, secondary maniaand bipolar disorder in old age." 46 : 175-182, 1997

10 "Diagnostic and Statistical Manual of PsychiatricDisease" American Psychiatric Press dc;1994

11 "Comparison of mania and depression after brain injury" 172-178, amjpsychiatry1988;145

12 "Cerebral infarct presenting as mania" 352-353, jclinpsychiatry1991;52

13 "Bipolardisorder following a stroke involving the left hemisphere" 30 : 688-691, 1996

14 "Bipolar disorderfollowing a left basal-ganglia stroke" brjpsychiatry1993;163

15 "A neuropsychologicalinvestigation of prefrontal cortex involvement inacute mania" 158 : 1605-1611, 2001