Clinical Reasoning: An Unusual Case of Acute Psychosis and Tetraparesis in a Young Zambian Man. (23rd November 2021)

• Record Type: Journal Article
• Authors: Zimba, Stanley; Chishimba, Lorraine; Chomba, Mashina; Saylor, Deanna
• Is Part Of: Neurology. Volume 97:Number 21(2021)
• Page Start: 1002
• Page End: 1005
• Publication Date: 2021-11-23
• Subjects: Neurology -- Periodicals; Neurology -- Periodicals; Neurologie -- Périodiques; 616.8
• DOI: 10.1212/WNL.0000000000012468
• Languages: English
• ISSNs: 0028-3878

Abstract

Abstract : A 27-year-old Zambian man presented to the neurology clinic with a 1-month history of mental status changes and a 5-day history of visual and auditory hallucinations, paranoia, and difficulty walking. Notably, a month before presentation, he became increasingly withdrawn and was diagnosed with depression in a psychiatry clinic. His medical history was also significant for an anal fissure with hematochezia and severe anemia (hemoglobin 4 g/dL) 6 months prior. Examination revealed a thin patient responding to auditory and verbal hallucinations who accused the examiner of trying to harm him. He had a spastic tetraparesis with 2/5 power in all limbs, hyperreflexia with clonus, and a palpable bladder and was unable to walk. Sensory examination was unreliable because of the patient's mental state.