Síndrome de Otelo secundario a tuberculoma cerebral: a propósito de un caso / Othello Syndrome Secondary to Cerebral Tuberculoma: A Case Report

RESUMEN Introducción: El síndrome de Otelo, epónimo del personaje de Shakespeare, es un término diagnóstico transnosológico que designa un cuadro caracterizado por delirios de infidelidad respecto a la pareja que, por consiguiente, puede acarrear actitudes celotípicas y conductas violentas hacia ella. En su forma pura, corresponde al trastorno delirante de infidelidad, pero también puede ser secundario a organicidad cerebral y a consumo de drogas. Métodos: Reporte de caso y revisión no sistemática de la literatura relevante. Presentación del caso: Varón de 26 arios con antecedente de consumo de drogas y víctima de maltrato infantil, 3 años antes había sufrido crisis convulsivas tónico-clónicas e hipertensión intracraneal, por lo que se sometió a una craneotomía, en la que se halló un tuberculoma cerebral frontal derecho. Tras un lapso, comenzó con delirios de infidelidad y conductas violentas hacia su pareja. Revisión de la literatura: Los celos delirantes se asocian, como otros delirios, a lesiones del lóbulo frontal derecho. Pese a la elevada y creciente prevalencia mundial de tuberculosis, no se han publicado casos de síndrome de Otelo secundario a tuberculoma cerebral. Conclusiones: El síndrome de Otelo, aunque no es la principal causa de violencia doméstica, puede asociarse con manifestaciones particularmente violentas y ser secundario a tuberculoma cerebral. Este es el primer caso de tal índole que se publica.

ABSTRACT Introduction: Othello syndrome, an eponym of Shakespeare's character, is a transnosological diagnostic term that designates a clinical picture characterised by the presence of delusions of infidelity with respect to a partner and that, consequently, can lead to typical jealousy attitudes and violent behaviour towards the partner. In its pure form, it corresponds to delusional disorder of infidelity, but it may also be secondary to brain organicity and drug use. Methods: Case report and non-systematic review of the relevant literature. Case presentation: A 26-year-old man, with a history of drug abuse and a victim of domestic violence as a child, presented with tonic-clonic seizures and intracranial hypertension three years ago, for which he underwent a craniotomy with the finding of a right frontal cerebral tuberculoma. After a lapse, he developed a clinical picture of delusions of infidelity regarding his partner and violent behaviour towards her. Literature review: Delusional jealousy is associated, like other delusions, with lesions of the right frontal lobe. Despite the high and growing prevalence of tuberculosis worldwide, there are no reported cases of Othello syndrome secondary to cerebral tuberculoma in the literature. Conclusion: Othello syndrome, although not the main cause of domestic violence, can be associated with particularly violent manifestations and be secondary to cerebral tuberculoma. This is the first published case of its kind.

Othello Syndrome Secondary to Cerebral Tuberculoma: A Case Report. / Síndrome de Otelo secundario a tuberculoma cerebral: a propósito de un caso.

INTRODUCTION: Othello syndrome, an eponym of Shakespeare's character, is a transnosological diagnostic term that designates a clinical picture characterised by the presence of delusions of infidelity with respect to a partner and that, consequently, can lead to typical jealousy attitudes and violent behaviour towards the partner. In its pure form, it corresponds to delusional disorder of infidelity, but it may also be secondary to brain organicity and drug use. METHODS: Case report and non-systematic review of the relevant literature. CASE PRESENTATION: A 26-year-old man, with a history of drug abuse and a victim of domestic violence as a child, presented with tonic-clonic seizures and intracranial hypertension three years ago, for which he underwent a craniotomy with the finding of a right frontal cerebral tuberculoma. After a lapse, he developed a clinical picture of delusions of infidelity regarding his partner and violent behaviour towards her. LITERATURE REVIEW: Delusional jealousy is associated, like other delusions, with lesions of the right frontal lobe. Despite the high and growing prevalence of tuberculosis worldwide, there are no reported cases of Othello syndrome secondary to cerebral tuberculoma in the literature. CONCLUSION: Othello syndrome, although not the main cause of domestic violence, can be associated with particularly violent manifestations and be secondary to cerebral tuberculoma. This is the first published case of its kind.

Síndrome de Capgras: una revisión breve / Capgras syndrome: a brief review

Los síndromes de falsa identificación, grupo de patologías neuropsiquiátricas, con las delusiones de falso reconocimiento como denominador común, incluyen, entre otros, al Síndrome de Capgras, caracterizado por la firme creencia, por parte del paciente, de que una persona cercana a él/ella, generalmente un familiar, ha sido sustituida por un doble exacto o impostor , describiendo la similitud física entre ambos; en pocos casos, tal creencia se extiende a animales domésticos e incluso a objetos inanimados. Un alto porcentaje de casos se asocia a un trastorno orgánico cerebral de base, especialmente demencias neurodegenerativas, pero también puede ocurrir en enfermedades psiquiátricas primarias, tales como esquizofrenia y trastornos esquizoafectivos o afectivos. La exploración neurobiológica plantea diferentes hipótesis explicativas del síndrome, entre ellas los modelos de desconexión visuoanatómico de Ellis y Young, de lateralización de Gainotti y de distribución de redes neuronales de Gobbini y Haxby. El falso reconocimiento puede dar lugar a conductas violentas del paciente contra las personas implicadas como supuestos dobles , especialmente en casos de pacientes varones, con enfermedad psiquiátrica de fondo (i.e., esquizofrenia paranoide), con antecedentes de consumo de sustancias psicoactivas o presencia concomitante de alucinaciones auditivas imperativas. No existe tratamiento específico para el Síndrome de Capgras, pero ciertamente el cuadro psiquiátrico subyacente debe ser manejado con fármacos antipsicóticos e incluso terapia electroconvulsiva.

The false identification syndromes, a group of neuropsychiatric pathologies with delusions of false recognition as their common denominator, include among others, the Capgras Syndrome, characterized by the patient s firm belief that a person close to him/her, usually a relative, has been replaced by an exact double or impostor , describing the physical similarity between both; in a few cases, such belief encompasses domestic animals or inanimate objects. A large percentage of cases are associated with a basic organic disorder, especially neurodegenerative dementias, but it can also occur in a basic psychiatric illness such as paranoid schizophrenia, schizoaffective or affective disorders. Among the neurobiological explanations of the Capgras Syndrome, different models have been described: visuo- anatomic disconnection by Ellis and Young, lateralization by Gainotti, neuronal networks distribution by Gobbini and Haxby. The false recognition can lead to violence against the people involved, especially by male patients with an underlying psychiatric illness (i.e., paranoid schizophrenia), a history of psychoactive substance use or the presence of imperative auditory hallucinations. There is no specific treatment for Capgras Syndrome but, certainly, management of the underlying psychiatric condition with antipsychotic drugs and even electroconvulsive therapy, should be initiated.

Paramnesia reduplicativa: a propósito de un caso asociado a esquizofrenia / Reduplicative paramnesia: a propos of a case associated with schizophrenia

Los síndromes de falsa identificación delusional (SFID) constituyen un cuadro clínico relativamente frecuente en la casuística psiquiátrica aunque la paramnesia reduplicativa (PR) se ha atribuido con más frecuencia a causas de tipo orgánico cerebral. Presentamos el caso de un paciente con diagnóstico de esquizofrenia paranoide, que desarrolló paramnesia reduplicativa afirmando que poseía dos domicilios iguales, uno verdadero y otro falso -copia del primero-, pero en este último no podía respirar porque no disponía de aire. Dentro de una breve revisión de la literatura respectiva, hallamos progresos en la explicación neurobiológica de la PR, sobre todo a partir del fenómeno hallado en pacientes con organicidad cerebral, sin embargo subsisten preguntas que pueden requerir una concepción más abarcativa de este síntoma en cuanto manifestación psicótica de la esquizofrenia.

Delusional misidentification syndromes (DMS) are a relatively common group of disorders in clinical psychiatry, although the symptom known as Reduplicative Paramnesia (RP) has been, in most cases, attributed to organic (brain- related) causes. The case of a patient with diagnosis of paranoid schizophrenia who developed RP is presented: he reported having two identical homes, one real and one false, the latter a copy of the former, but in which he could not breathe because of lack of air. A brief review of the literature revealed progress in the neurobiological explanation of RP, particularly related to evidences of organic cerebral pathology; nevertheless, a number of questions remain, requiring a more comprehensive conception of this symptom as a psychotic manifestation of schizophrenia.

Factores asociados a la incidencia de hipernatremia intrahospitalaria en pacientes adultos de un servicio de medicina de Lima, Perú / Factors associated with hospital-acquired hypernatremia in adult patients in an internal medicine service in Lima, Peru

Objetivos: Identificar las variables asociadas con la hipernatremia en pacientes adultos hospitalizados en el serviciode Medicina de un hospital general de Lima, Perú. Material y métodos: Estudio modelo de casos y controles depacientes hospitalizados en el servicio de Medicina del Hospital Cayetano Heredia en el año 2013. Se calculó untamaño de muestra de 65 casos y 65 controles para obtener un OR de 3 con una potencia del 80% y una confianza del95%, apareados por época de hospitalización y Score Glasgow...

Objectives: To identify variables associated with hypernatremia in adult patients admitted in an internal medicineservice in a general hospital in Lima, Peru. Methods: Case-control study of patients admitted in the Internal Medicineservice of Hospital Cayetano Heredia during 2013. A sample size of 65 cases and controls, matched by date ofadmission and Glasgow coma scale, to obtain an OR of 3 with 80% power and 95% confidence was estimated...