Severe delirium due to basal forebrain vascular lesion and efficacy of donepezil.
A severe intractable delirium caused by the basal forebrain vascular lesion and its dramatic recovery after donepezil administration were reported. A 68-year-old man had suffered for a month from delirium of mixed type caused by the right basal forebrain vascular lesion after surgery for craniopharyngioma. Magnetic resonance imaging (MRI) showed hemorrhagic infarcts in the head of the right caudate nucleus and the right basal forebrain of the medial septal nucleus, diagonal band of Broca and nucleus basalis of Meynert. He had been treated with anti-psychotics, anti-depressants and hypnotics, which resulted in little improvement. Donepezil administration dramatically improved his intractable delirium at the 19th post-donepezil administration day, but this was followed by amnestic symptoms. Clinical correlates of delirium with the basal forebrain lesion and efficacy of donepezil support the hypocholinergic theory of delirium.
Kobayashi
Katsuji
K
Department of Psychiatry and Neurobiology, Kanazawa University Graduate School of Medical Sciences, 13-1, Takara-machi, Kanazawa, Ishikawa-ken, 920-8641, Japan. kobakatu@med.m.kanazawa-u.ac.jp
Higashima
Masato
M
Mutou
Kouhei
K
Kidani
Tomokazu
T
Tachibana
Osamu
O
Yamashita
Jonkoh
J
Koshino
Yoshifumi
Y
D000368:Aged; D020144:Basal Ganglia Cerebrovascular Disease / Q000188:drug therapy* / Q000473:pathology; D020532:Basal Nucleus of Meynert / Q000473:pathology; D003397:Craniopharyngioma / Q000150:complications / Q000601:surgery; D003693:Delirium / Q000188:drug therapy* / Q000209:etiology*; D000077265:Donepezil; D006801:Humans; D007189:Indans / Q000627:therapeutic use*; D008279:Magnetic Resonance Imaging; D008297:Male; D018697:Nootropic Agents / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000523:psychology; D016548:Prosencephalon / Q000473:pathology*; D012893:Sleep Wake Disorders / Q000188:drug therapy / Q000209:etiology; D014786:Vision Disorders / Q000150:complications
D007189:Indans; D018697:Nootropic Agents; D010880:Piperidines; D000077265:Donepezil