Akathisia caused by traumatic brain injury in an adolescent

Year 2019, , 577 - 580, 30.09.2019

Sezai Üstün Aydın , Gülşen Ünlü , Serdar Avunduk

https://doi.org/10.31362/patd.526327

Abstract

Introduction

Akathisia is a clinical
condition with subjective complaints such as restlessness, mental unease, an
urge to move or dysphoria. It is usually caused by basal ganglion diseases and
medication. But rarely it may also occur due to traumatic brain injury (TBI).
In this case report, a 17 years old patient was discussed, who developed
akathisia after TBI and had no neuropsychiatric disorder history.

Case

The patient was admitted to
the child and adolescent psychiatry clinic with constant complaints of motor
restlessness. Three weeks ago he was hospitalized with multiple fractures,
subarachnoid and epidural hemorrhage, cerebral edema after a car accident.
Risperidone 0,5mg/day treatment started for agitation. Two days later symptoms
got worsened, consequently risperidone treatment was changed to propranolol
60mg and lorazepam 7,5 mg daily, following the change of diagnosis to akathisia
caused by TBI. There was a significant improvement in akathisia symptoms in
days. Akathisia treatment was stopped at the end of three weeks without
symptoms.

Conclusion

Akathisia
caused by TBI is an important clinical condition that affects the treatment and
the rehabilitation negatively, which also can be misdiagnosed as agitation or
delirium. Thus it should be kept in my mind for differential diagnosis and its
treatment should not be delayed

Keywords

akathisia, traumatic brain injury, adolescent, psychomotor agitation, lorazepam

Bir ergende travmatik beyin hasarına bağlı akatizi

Abstract

              Giriş   

Akatizi yerinde
duramama, iç huzursuzluk, tedirginlik veya disfori gibi yoğun olabilen öznel
yakınmaları olan bir klinik durumdur. Genellikle bazal
ganglion hastalıklarında, antipsikotik vd. anti-dopaminerjik etkisi olan
ilaçlarda görülür. Ayrıca nadiren travmatik beyin hasarına (TBH) bağlı ortaya
çıkabilir. Bu olgu sunumunda öncesinde psikotrop ilaç kullanımı veya bilinen
bir nörolojik rahatsızlığı olmayan, araç içi trafik kazası sonrası travmatik
beyin hasarına bağlı akatizi gelişen 17 yaşındaki olgu tartışılmıştır

            Olgu  

17 yaşında erkek
ergen hasta sürekli motor huzursuzluk şikayeti ile ayaktan çocuk ve ergen
psikiyatrisi polikliniğine başvurdu. Üç hafta önce araç içi trafik kazası
sonrası çoklu kırık, subaraknoid ve epidural kanama ve serebral ödem ile
yatışının olduğu öğrenildi. Ajitasyona yönelik risperidon 0,5mg/gün tedavisi
başlanıldı. İki gün sorna semptomların kötüleşmesi üzerine tanı TBH’a bağlı
akatizi olarak değiştirildi ve risperdion kesilerek yerine propranolol ve
lorazepam reçete edildi. Günler içinde akatizi semptomlarında düzelme gözlendi.
Üç haftanın sonunda semptomlar tekrar etmeden tedavi sonlandırıldı.

            Sonuç           

TBH’a bağlı akatizi
tedavi ve rehabilitasyon süreçlerini olumsuz etkileyen önemli bir klinik
tablodur, ajitasyon ve delirium ile kolaylıkla karışabilmektedir. Bu nedenle
ayırıcı tanıda akılda tutulmalı ve tedavisi geciktirilmemelidir.

Keywords

akatizi, travmatik beyin hasarı, psikomotor ajitasyon, ergen, lorazepam

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