Unilateral hippocampal infarction associated with an attempted suicide: a case report.
Unilateral hippocampal infarction associated with an attempted suicide: a case report.
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DOI：
10.1186/1752-1947-8-219
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发表时间：
2014-06-23
影响因子：
1
通讯作者：
Kato S
中科院分区：
文献类型：
--
作者：
Nishiyori Y;Nishida M;Shioda K;Suda S;Kato S
在我们的病例报告中，我们描述了一名患者的病例，该患者在服用草甘膦过量自杀未遂后发现左海马中风。据我们所知，这是第一例描述与药物过量相关的海马梗塞的病例报告。一名64岁的日本妇女在摄入未知剂量的草甘膦表面活性剂除草剂后被带到我们的急诊室试图自杀。入院时，她被认为患有抑郁症或精神疾病，然而，突然发作的记忆缺陷变得明显。病人表现出谵妄、精神错乱和严重焦虑。此外，短期记忆丧失是突出的，病人忘记了她企图自杀。在一系列标准测试和大脑计算机断层扫描（仅显示了一个旧的梗塞）之后，我们进行了磁共振成像扫描和神经心理学评估。脑部磁共振成像显示，在左侧海马体的背侧部分有一个小的高强度病变，记忆测试显示出严重的短期回忆缺陷。我们诊断她患有左侧海马梗死，并给予75 mg氯吡格雷治疗。在一周的时间里，她逐渐变得不那么困惑了，后续的记忆测试显示，她在某些领域有了部分改善。在后续的脑部扫描中没有发现异常。然而，尽管康复，记忆障碍仍然存在。重要的是要注意，如果短期记忆的症状不存在或不那么严重，她可能被误诊为抑郁症或其他精神疾病。虽然计算机断层扫描未能发现海马病变，弥散加权磁共振成像扫描清楚地显示了左侧海马内的病变。因此，除了对可能是自杀未遂根本原因的精神疾病进行评估外，还应沿着考虑器质性因素以及放射学检查和精确的记忆评估，以诊断类似病例。
In our case report we describe the case of a patient who experienced a stroke in her left hippocampus that was found following an attempted suicide via glyphosate overdose. To the best of our knowledge this is the first case report to describe a hippocampal infarction associated with a drug overdose. A 64-year-old Japanese woman was brought to our emergency department after ingestion of an unknown dose of glyphosate surfactant herbicide in order to attempt suicide. On admission, she was assumed to be presenting with depression or psychiatric illness, however, sudden-onset memory deficit became apparent. The patient manifested delirium, confusion, and severe anxiety. In addition, short-term memory loss was prominent, with the patient forgetting her attempted suicide. Following an array of standard tests and a brain computed tomography scan (which only showed an old infraction), we performed a magnetic resonance imaging scan and neuropsychological evaluations. The brain magnetic resonance image revealed a small high-intensity lesion in the dorsal part of the left hippocampal body, and memory tests demonstrated severe short-term recall deficits. We diagnosed her with a left hippocampal infarction and administered a course of 75mg of clopidogrel. She gradually became less confused over the course of a week, and a follow-up memory test revealed partial improvement in some domains. No abnormalities were found on a follow-up brain scan. However, despite rehabilitation, memory impairments remain. It is important to note that had the symptom of short-term memory been absent or less severe, she might have been misdiagnosed with depression or another psychiatric illness. Although a computed tomography scan failed to detect hippocampal lesions, a diffusion-weighted magnetic resonance imaging scan clearly revealed a lesion within the left hippocampus. Therefore, in addition to assessments focusing on psychiatric illnesses that might be the root cause of an attempted suicide, organic factors should be considered along with radiological examination and precise memory assessments for diagnosing similar cases.