[Delusional disorder of the paranoid type and unruptured intracerebral aneurysm--is there an association?]. / Sumanuti poremecaj paranoidnog tipa i nerupturirana intracerebralna aneurizma--postoji li povezanost?

ABSTRACT

INTRODUCTION: Contrary to ruptured intracerebral aneurysm, according to our knowledge, not many papers have been published dealing with the relation of psychic/neuropsychological symptoms and unruptured intracerebral aneurysm (UIA). As to our knowledge, there is no published paper relating delusional disorder, paranoid type (DD-PT) and UIA, which can have important clinical implication. AIM, METHOD AND RESULTS: We describe a case of a woman who had DD-PT and UIA. The patient in her fifties, a typist with elementary school education, presented to the psychiatrist with the symptoms of irritability, insomnia, suspiciousness and paranoid ideas lasting for about a year. She showed clear symptoms of a delusional disorder. The psychiatrist established the diagnosis of DD-PT according to ICD-10. Olanzapine therapy, 10 mg day, was introduced immediately, causing partial improvement. In further diagnostic procedure, psychological tests were performed. The finding confirmed the diagnosis and average intellectual efficacy. The additional findings of impaired verbal fluency (VF) and hand tremor signalized an organic origin. The patient was referred to a neurologist, who assessed hand tremor, but otherwise the finding was normal. Brain CT revealed the possible UIA. Neurological hospitalization was quickly organized, and the definitive diagnosis of basilar artery aneurysm of 22 mm in diameter was made by angiography. Several days later, osteoplastic supraorbital craniotomy was performed at the neurosurgical department, with right sided keyhole approach in microsurgical technique, and the aneurysmal neck was clipped. The postoperative course was accompanied by meningitis treated with antibiotics. In neurological status, cerebellar symptomatology, tremor of the left hand, mild hemiparesis on the left side and the right eyelid ptosis persisted. Paranoid delusions were absent, but depressive symptoms emerged. Eight months after the surgery (approx. 11 months after the first test), control psychological testing was performed. The finding showed depression with significant perceptive disorganization. The VF result was within the normal limits. The patient is still being continuously followed-up. During preliminary diagnostic work-up, the possible organic cause and/or relation was suspected, based only on the psychiatric assessment and psychological report, because neurological status was free from any abnormalities other than tremor of the hands. CONCLUSION: The reported case confirmed the importance of detailed psychiatric interview and psychological testing in persons with psychic disorders, as well as the importance of multidisciplinary approach in the diagnosis and therapy. In this case, we could not find the exact way of connection between DD-PT and UIA.