Priscilla Chukwueke obtained her medical degree from American International School of Medicine, Guyana, South America, and has a Master’s degree in public health. She is currently pursuing her psychiatry residency at Harlem Hospital /Columbia University in New York, USA. This case report was done in conjunction with a neurologist- Dr. Anne Kleiman and a radiologist- Dr Leszek Pisinski all from Harlem Hospital / Columbia University and it has been published in clinical Neuropsychiatry journal in June 2015. She has presented posters nationally and internationally e.g. at The World psychiatric Congress in Madrid Spain in 2014.
Introduction: MBD is a rare central nervous system (CNS) disease characterized by demyelination of the corpus callosum mostly found in men with alcohol use disorder and malnutrition with cases reported worldwide across all races. The onset of the disease may be sudden presenting with stupor, coma or seizures while some may present with gait abnormality (spasticity), psychiatric problems, hemiparesis, aphasia, apraxia and incontinence with a resultant high morbidity and mortality rates. Case description: patient is a 30 year old left handed African-American with history of hypertension, diabetes type I, hypothyroidism, alcohol use disorder, who presented with c/o altered mental status, urinary incontinence, slurred speech and left-sided weakness. Work up was done to r/o acute ischemic stroke or hemorrhage, other causes of encephalopathy, seizures with post ictal state and all were negative. Lab findings was significant for anemia and hypoalbuminemia. He was followed by psychiatry for suicidal ideation, depression and agitation, CT brain without contrast was unremarkable but MRI brain showed bilateral centrum ovale restricting lesion with restriction in splenium of the corpus callosum. The diagnosis of MBD was confirmed with DTI Tractography which showed significantly diminished commissural fibers extending to the right central semiovale lesion, near absent or significantly diminished commissural fiber extending through the corpus callosum indicating demyelination. Management included empirical management for meningitis, seizures followed by management of malnutrition with dietary supplements, multivitamins and rehabilitation. He responded to treatment evidenced by resolution of his presenting symptoms and by day ten of hospitalization, he was cleared and discharged to home to follow up in the outpatient clinic. Discussion: MBD is often an incidental diagnosis with high morbidity and mortality. This is different from previous casas because of earlier onset as opposed to onset around age 45, rapid recovery and minimal disability as he could work independently before discharge from hospital. This case also shows added benefit of the DTI tractography in the diagnosis of MBD.
Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
Objective: Patients with BP-II have a higher prevalence rate of metabolic disturbance and obesity than do the general population. Genetic variants of the methylenetetrahydrofolate reductase (MTHFR) gene have been regarded as predictors of weight gain in schizophrenia. In the present study, we investigated whether the MTHFR C677T polymorphism may predict changes in metabolic indices after 12 weeks of treatment in patients with BP-II. Methods: First diagnosed patients (n = 117) with BP-II according to DSM-IV criteria were recruited. Metabolic profiles (cholesterol, triglyceride, HbA1C, fasting serum glucose, body mass index (BMI)) were measured at baseline and 2, 8, and 12 weeks post-treatment. The genotype of the MTHFR polymorphism was determined using a polymerase chain reaction-restriction fragment length polymorphism analysis. Multiple linear regressions with generalized estimating equation methods were used for analysis of repeated assessments. Results: Seventy-six (65.0%) patients completed the intervention. Significantly difference in BMI change was associated with the MTHFR C677T genotypes (P = 0.005). Patients with the C/C genotypes had higher frequency of metabolic syndrome at baseline than those with the C/T+T/T genotypes; no significant difference in frequency of metabolic syndrome was found at between the two genotypes after 12 weeks of treatment. Conclusion: We conclude that the MTHFR C677T polymorphism is associated with changes in BMI and metabolic syndrome in BP-II patients after 12 weeks of treatment.