Case report: bipolar disorder as the first manifestation of CADASIL

BMC Psychiatry

Case Report

Soyeon Park¹  Yeon Ho Joo¹  Boram Park¹  Min Kyung Koh² 

[1] Department of Psychiatry, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, 136-736, Songpa-gu, Seoul, South Korea;Department of Psychology, Asan Medical Center, 88 Olympic-ro 43-gil, 136-736, Songpa-gu, Seoul, South Korea;

关键词: CADASIL;    Bipolar disorder;    Mood disorder;    NOTCH3;   

DOI  :  10.1186/1471-244X-14-175

 received in 2013-08-21, accepted in 2014-06-11,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundCerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebrovascular disease, clinically characterized by variable manifestations of migraine, recurrent transient ischemic attack or lacunar strokes, cognitive decline, and mood disturbances. However, manic episodes have rarely been documented as an initial symptom of CADASIL and bipolar disorder presenting as the first manifestation in CADASIL has not been reported previously from evaluations by psychiatrists or psychological testing by psychologists.Case presentationA 53 year old woman developed symptoms of mania in her 50s leading to a personality change involving a continuously labile mood and irritability over a number of years. Neuropsychological testing revealed an intact memory, but impairment in attention and executive function. In the Rorschach test, she showed a high level of cognitive rigidity. Magnetic resonance imaging findings were very consistent with a diagnosis of CADASIL, which was confirmed by genetic testing for NOTCH3 mutations. Atypical antipsychotics proved to be helpful in treating her manic symptoms and for behavior control.ConclusionWe present a novel case of CADASIL that first presented as bipolar disorder. We contend that when patients show a late onset personality change or chronically irritable mood that deteriorates over many years, an organic cause such as CADASIL must be considered. Further studies are needed to better understand the exact impacts of cerebral tissue lesions and psychiatric symptoms in CADASIL patients.

【 授权许可】

Unknown   
© Park et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.