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Confusion between symptom and disease. Parkinson vs meningioma

Published online by Cambridge University Press:  23 March 2020

M.J. Gordillo Montaño
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
S. Ramos Perdigues
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
C. Merino del Villar
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
C. Caballero Roy
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
S. Latorre
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
M. Guisado Rico
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
A. Bravo Romero
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
S.V. Boned Torres
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain
M. de Amuedo Rincon
Affiliation:
Hospital Can Misses, psychiatry, Eivissa, Spain

Abstract

Introduction

Parkinson's disease is caused by decreased dopaminergic neurons of the substantia nigra. Psychosis occurs between 20 and 40% of patients with Parkinson's disease. Dopaminergic drugs act as aggravating or precipitating factor. Before the introduction of levodopa patients had described visual hallucinations but the frequency was below 5%.

Objective

Illustrated importance of treatment, reassessment after its introduction and refractoriness to answer; as well as the importance of a differential diagnosis at the onset of psychotic symptoms later in life.

Method

Clinical case: female patient 75 years tracking Neurology by parkinsonism in relation to possible early Parkinson disease. She was prescribed rasagiline treatment. Begins to present visual and auditory hallucinations, delusional self-referential and injury. She had no previous psychiatric history. She went on several occasions to the emergency room, where the anti-Parkinson treatment is decreased to the withdrawal point and scheduled antipsychotics did not answer. Doses of antipsychotics are increased despite which symptoms persist and even increase psychotic symptoms. In this situation it is agreed to extend the study. Subsequently an NMR of the skull where the image is suggestive of a right occipital meningioma appears.

Results/conclusions

With the emergence of psychotic symptoms later in life it will be important to ask a broad differential diagnosis, since in a large number of cases will be secondary to somatic or to drug therapies.

Parkinsonism can be a symptom of occipital meningioma, presenting in the psychotic clinic. Refractoriness, on one hand to the suspension of treatment for Parkinson's disease, such as poor response to antipsychotics, did extend the study, which ultimately gave us the diagnosis.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Type
e-Poster viewing: Consultation liaison psychiatry and psychosomatics
Copyright
Copyright © European Psychiatric Association 2017
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