Psicose Aguda Isolada como Apresentação de Trombose Venosa Cerebral Recorrente
DOI:
https://doi.org/10.51338/rppsm.665Palavras-chave:
Perturbações Psicóticas, Trombose dos Seios Intracranianos/diagnóstico, Trombose Venosa/diagnósticoResumo
A trombose venosa dos seios cerebrais (TVSC) é uma causa rara de AVC, geralmente com sinais neurológicos inespecíficos, manifestando-se, ocasionalmente, por sintomas psiquiátricos isolados. Uma mulher de 28 anos sem história psiquiátrica prévia, apresentou com dois episódios de psicose aguda após TVSC. No primeiro, durante uma viagem à Tailândia desenvolveu um quadro de irritabilidade, delírios e insónia com estudo inicial normal. A RM revelou trombose da veia cortical parietal esquerda. Iniciou anticoagulação subcutânea e antipsicóticos, com resolução gradual. Quatro anos depois, após voo para a Madeira, desenvolve nova psicose aguda, sem outros défices neurológicos; a RM confirmou trombose extensa do seio lateral esquerdo e veia jugular interna. Excluíram-se causas infeciosas, autoimunes e neoplásicas. O estudo de trombofilias mostrou fator VIII elevado e variantes em SERPINE1 e na protrombina. A TVSC pode apresentar-se exclusivamente como psicose, sem défices focais, sendo a neuroimagem precoce crucial para o diagnóstico e tratamento eficazes.
Downloads
Referências
Bousser MG, Ferro JM. Cerebral venous thrombosis: An update. Lancet Neurol. 2007;6:162-70. doi: 10.1016/S1474-4422(07)70029-7. DOI: https://doi.org/10.1016/S1474-4422(07)70029-7
Louis F, Yelwatkar S, Sathe H, Karia S. Psychosis as Initial Clinical Presentation for Cerebral Venous Thrombosis: A Case Report. Ind J Priv Psychiatry 2024;18:39-41. doi: 10.5005/jp-journals-10067-0144. DOI: https://doi.org/10.5005/jp-journals-10067-0144
Bobba NS, Shirah B, Alassiri A. Atypical presentation of CVST as bradycardia and psychosis. Telangana J Psychiatry. 2020;6:96-8. doi: 10.18231/j.tjp.2020.019. DOI: https://doi.org/10.18231/j.tjp.2020.019
Alghatani H. Cerebral venous sinus thrombosis presenting as schizophrenia. Neuroscience. 2015;20:292. DOI: https://doi.org/10.17712/1658-3183.2119
Ozdilek B. Consideration of Cerebral Venous Thrombosis as a Cause of Delirium in Psychiatry Clinics. Bull Clin Psychopharmacol. 2015;25:2. 190-2. doi: 10.5455/bcp.20130715083533. DOI: https://doi.org/10.5455/bcp.20130715083533
Ferro JM, Canhao P, Bousser MG, Stam J, Barinagarrementeria F; ISCVT Investigators. Cerebral vein and dural sinus thrombosis in elderly patients. Stroke. 2005;36:1927-32. doi: 10.1161/01. STR.0000177894.05495.54. DOI: https://doi.org/10.1161/01.STR.0000177894.05495.54
American Psychiatric Association, DSM-5 Task Force. Diagnostic and statistical manual of mental disorders. 5th ed. Washington: American Psychiatric Association; 2013. DOI: https://doi.org/10.1176/appi.books.9780890425596
Ghoneim A, Straiton J, Pollard C, Macdonald K, Jampana R. Imaging of cerebral venous thrombosis. Clin Radiol. 2020;75:321-31. doi: 10.1016/j.crad.2020.01.002 DOI: https://doi.org/10.1016/j.crad.2019.12.009
Souza-Couto D, Bretas R, Aversi-Ferreira TA. Neuropsychology of the parietal lobe: Luria's and contemporary conceptions. Front Neurosci. 2023;17:1226226. doi: 10.3389/fnins.2023.1226226. DOI: https://doi.org/10.3389/fnins.2023.1226226
Sirigu A, Daprati E, Pradat-Diehl P, Franck N, Jeannerod M. Perception of self- generated movement following left parietal lesion. Brain. 1999;122:1867-74. doi: 10.1093/brain/122.10.1867. DOI: https://doi.org/10.1093/brain/122.10.1867
Kikkert MA, Ribbers GM, Koudstaal PJ. Alien hand syndrome in stroke: a report of 2 cases and review of the literature. Arch Phys Med Rehabil. 2006;87:728-32. doi: 10.1016/j.apmr.2006.02.002. DOI: https://doi.org/10.1016/j.apmr.2006.02.002
Doricchi F, Tomaiuolo F. The anatomy of neglect without hemianopia: a key role for parietal-frontal disconnection? NeuroReport. 2003;14:239-43. doi: 10.1097/00001756-200312020-00021. DOI: https://doi.org/10.1097/00001756-200312020-00021
Spence SA, Brooks DJ, Hirsch SR, Liddle PF, Meehan J, Grasby PM. A PET study of voluntary movement in schizophrenic patients experiencing passivity phenomena (delusions of alien control). Brain. 1997;120:1997-2011. doi: 10.1093/brain/120.11.1997. DOI: https://doi.org/10.1093/brain/120.11.1997
Sindrome neuroléptica maligna. Rev Brasil Clin Méd. 2012;10:440-5. doi: 10.1590/S0004-282X2011000600005. DOI: https://doi.org/10.1590/S0004-282X2011000600005
Brockington IF. Post- partum transverse sinus thrombosis presenting as acute psychosis. Arch Womens Ment Health. 2010;13:365-7. doi: 10.1007/s00737-009-0124-z. DOI: https://doi.org/10.1007/s00737-009-0124-z
Brockington IF. Cerebral vascular disease as a cause of postpartum psychosis. Arch Womens Ment Health. 2007;10:177-8. doi: 10.1007/s00737-007-0187-7.10. DOI: https://doi.org/10.1007/s00737-007-0187-7
von Mering M, Stiefel M, Brockmann K, Nau R. Deep cerebral venous sinus thrombosis often presents with neuropsychologic symptoms. J Clin Neurosci. 2003;10:310-2. doi: 10.1016/s0967-5868(03)00017-1. DOI: https://doi.org/10.1016/S0967-5868(03)00017-1
Hall PL, Lam C, Wolfe L, Edmondson A, Acmg Laboratory Quality Assurance Committee. Biochemical testing for congenital disorders of glycosylation: A technical standard of the American College of Medical Genetics and Genomics (ACMG). Genet Med. 2025;27:101328. doi: 10.1016/j.gim.2024.101328. DOI: https://doi.org/10.1016/j.gim.2024.101328
