Starvation causes acute psychosis due to anterior thalamic infarction.
A 19-year-old female presented with acute onset of bizarre behavior, confusion, auditory hallucinations, and delusions after two weeks on a 100 kcal/day diet. She had a normal neurological examination. Urinalysis showed ketones 4+. She had elevated antinuclear antibody (ANA) (320) and positive heterozygous factor V Leiden mutation. Magnetic resonance imaging brain scan showed hyperintensity in the ventroanterior nucleus of the left thalamus. Ventroanterior thalamic stroke has been associated with personality changes. This is the first case of starvation-induced thalamic psychosis in the setting of factor V Leiden mutation and elevated ANA. The patient improved with risperidone in one month.
Department of Neurology, Kansas University Medical Center, Kansas City, KS, USA. drmanojkumarmittal@gmail.com
Manoj
M
Mittal
Saud
S
Khan
D000208:Acute Disease; D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D005165:Factor V / Q000235:genetics; D005260:Female; D006801:Humans; D007238:Infarction / Q000150:complications* / Q000209:etiology; D007662:Ketosis / Q000209:etiology; D049268:Positron-Emission Tomography; D011618:Psychotic Disorders / Q000188:drug therapy / Q000209:etiology*; D018967:Risperidone / Q000627:therapeutic use; D013217:Starvation / Q000150:complications* / Q000523:psychology; D013788:Thalamus / Q000098:blood supply*
D014150:Antipsychotic Agents; C095381:factor V Leiden; D005165:Factor V; D018967:Risperidone