The paper reviewed here is ‘A possible case of mixed mania due to neurosarcoidosis treated successfully with methylprednisolone and ziprasidone: another example of frontal-subcortical disinhibition?’ by Kent and colleagues. This is a very brief case report on an African-American lady in her late 30’s who presents with hypomania and a previous suspicion of pulmonary/cardiac sarcoidosis on the basis of biopsy. The authors note that this was not treated although I wasn’t sure of the reason for this. She had been presenting with intermittent facial nerve palsy also. These details were confirmed on physical examination during the admission described in the report. There was no evidence of delirium although she was expressing bizarre delusions in the context of a labile mood. A provisional diagnosis of mania with psychotic symptoms was made and she was treated with a combination of Ziprasidone and Prednisolone and her hypomanic state had improved within 2 days. They provide supporting scores on the Young Mania Rating Scales, both on admission and discharge. The lady wasn’t able to undergo an MRI scan as she had a pacemaker and there was no evidence of neurosarcoidosis from the investigations although this was the presumed diagnosis. The authors suggest that Haloperidol given initially on admission or the Ziprasidone may have been associated with the rapid improvement as they cite other literature suggesting that response of psychiatric symptoms to steroid monotherapy in sarcoidosis takes between 2 and 4 weeks. The authors also note that without the radiological exclusion of alternative diagnoses they were not strictly able to confirm the neurosarcoidosis (NS) diagnosis on the basis of Zajicek’s criteria. Another possibility was this was Bipolar disorder.
I did a quick search of medline using the keyword ‘neurosarcoidosis’ as of 31.5.10 returned 543 results. I have listed a few of the papers that looked interesting below.
- Canadian case study of ongoing cognitive decline in association with NS.
- Presentation and management. American 2010 paper.
- Clinical manifestations. Croatian 2010 paper.
- FDG-PET in diagnosis of NS. German 2009 paper.
- Presentation as hypersomnia. Japanese 2009 paper.
- Outcome of 54 cases. American 2009 paper.
- Occurrence of MoyaMoya-like vasculitis with NS. South Korean 2009 paper.
- Correlation of MR and clinical findings. Free full text article. 2009 American paper.
- Treatment with antibody and immunosupressant. 2009 American paper.
- Dutch study on presentation as manic psychosis – as in current case report. Free full text but article is in Dutch.
- Uk study of 30 cases.
Spiegel D.R, Thomas C.S, Shah P and Kent K.D. A possible case of mixed mania due to neurosarcoidosis treated successfully with methylprednisolone and ziprasidone: another example of frontal-subcortical disinhibition? General Hospital Psychiatry. Vol 32. Issue 3. May-June 2010. pp342.
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