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Dr. Muneeb Ali
Dr. Muneeb Ali, Intensivist
Category: Eye
Satisfied Customers: 3191
Experience:  MBBS, MD, MCCM.Currently working in Critical Care Medicine with 10 year experience in Medicine
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Dr Su S, my daughter aged 19yrss had an episode of acute

Customer Question

Hi, Dr Su S, my daughter aged 19yrss had an episode of acute psycosis almost a month ago. She was admitted to a psychiatric hospital and they have been administering antipsychotic drugs which are taking an abnormal amount of time to take effect (3 weeks) she has had very little progress. She is not in control of her own functions, droopy eyes, fatigue, she doesn't recognize me as her mother... I scare her and she says she hates me. We have never had a bad relationship before. We have lived in Africa for 5 years in undeveloped countries, Malawi and now Zambia. I am wondering if she has not come into contact with a virus as she has also presented days of running a fever. Could it be a parasite causing this such as tapeworm etc?
Submitted: 1 year ago.
Category: Eye
Expert:  Dr. Muneeb Ali replied 1 year ago.

Hi,

Im very sorry to hear about your daughter. I see Dr Su S hasnt responded to your question yet, so ill leave a answer here for you.

Well from what you are describing there are few things which MUST be considered before labelling the patient as a case of psychosis. The patient has to be extensively investigated for any organic pathology and various scans and tests have to be done. Especially in the case of acute psychosis.

Now as far as your question is concerned, its possible that she has neurocystiscercosis. It can present with neuropsychiatric disturbances, seizures, weakness in limbs and arms, behavioural changes as well as a fever and can lead to unconsciousness, coma and death. This can progress over the course of several weeks to a couple of months but eventually will cause a coma. The thing with this disease is that it can be easily diagnosed on brain imaging. This would include a CT scan along with a MRI of the brain. The cases of neurocystiscercosis that i have seen have almost always been picked up on a MRI of the brain, provided there is suspicion on part of the treating physician.

Apart from neurocystiscercosis, (tapeworm), it can also be due to any other infectious etiology of the brain. I hope they have done a lumbar puncture which means they have tested the fluid from her spine and looked for viral infections. Viral encephalitis can present in this manner and requires anti virals for treatment. Secondly considering the location where you live, i wouldn't exclude this being tuberculosis of the brain. It can be tuberculous meningitis but given her symptoms its possible that it is tuberculous encephalitis. Sometimes this is difficult to diagnose but again in both of the above cases, a MRI along with lumbar puncture is needed nonetheless.

In addition once this is done, she should also be investigated for any metabolic abnormalities which can lead to altered mental status. But i would say once the lumbar puncture and MRI is done, this could help in eliminating many of the common problems which i have mentioned above. I would suggest that you have a neurologist look into her problem and have him run the above tests. She needs the following tests done,

1) Complete blood profile, including chemistry profile

2) ESR

3) Mauntoux test

4) CSF RE and gram + ZN staining

5) CT scan brain or MRI brain with and without contrast

Once these are done we can look into etiologies which can cause the fatigue and droopy eyes, like myasthenia but it wouldn't cause acute psychosis. If this is still considered an acute organic problem (that is related to the brain) then at the very last we can consider looking into spongiform encephalopathies like kuru-kuru, creudzfelt-Jakob disease etc.

But i would first rule out infectious etiologies like viral encephalitides and tuberculosis as well as parasitic infections first.

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Expert:  Dr. Muneeb Ali replied 1 year ago.

Do you have anymore questions? If done for now, please leave a positive feedback rating as i am not compensated for my time until you do. You can always ask follow up questions after that.

Expert:  Dr. Muneeb Ali replied 1 year ago.

Do you have anymore questions? If done for now, please leave a positive feedback rating as i am not compensated for my time until you do. You can always ask follow up questions after that