Adult Mild Encephalitis With Reversible Splenial Lesion Associated With Delirious Mania: A Case Report

• Main Authors: Marcella Bellani, Giovanni Zanette, Niccolò Zovetti, Marco Barillari, Lidia Del Piccolo, Paolo Brambilla
• Format: Article
• Language: English
• Published: Frontiers Media S.A. 2020-02-01
• Series: Frontiers in Psychiatry
• Subjects: encephalitis; manic state; neuroimaging; deep sedation; propofol
• Online Access: https://www.frontiersin.org/article/10.3389/fpsyt.2020.00079/full

Mild encephalitis with reversible splenial lesion is a rare clinic-radiological entity presenting with neurological and neuropsychiatric symptoms associated with cerebral lesion/s. Delirious mania is a severe psychiatric syndrome characterized by acute onset of delirium, excitement, and psychosis with a high mortality rate. In this paper, we present a case report of mild encephalitis with reversible splenial lesion clinically presenting as delirious mania and evolving into life-threatening multi-organ failure. The patient was treated with aripiprazole and benzodiazepine with poor effect and, after 4 days, the patient's condition significantly worsened requiring transfer to the intensive care unit where deep sedation with propofol was started. Our findings are in contrast with the traditional literature description of self-resolving and harmless mild encephalitis with reversible splenial lesion. Moreover, rapid clinical recovery and the progressive improvement of psychiatric symptoms after deep sedation with propofol in this case—considering propofol's neuroprotective and anti-inflammatory effects—supports the notion of propofol-mediated deep sedation for the treatment of severe manic symptoms associated with life-threatening conditions. Little is known about neural markers of the manic state, and the corpus callosum has been described to be involved in bipolar disorder. Abnormalities in this structure may represent a marker of vulnerability for this disorder.