Akathisia caused by traumatic brain injury in an adolescent

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

Öz

              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.

Anahtar Kelimeler

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

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