Acute psychomotor agitation – challenges for psychiatrists and neurologists: a case study

PURPOSE: Bilateral thalamic ischemia can, paradoxically, manifest itself with various non-sensory clinical symptoms, thereby complicating diagnosis. CASE DESCRIPTION: A 59-year-old woman was admitted to an Emergency Department about and hour and a half after she was found with altered mental status. Her initial symptoms were psychomotor agitation and slight confusion. No evident focal neurological deficit was observed at that time and computed tomography was negative. After acute drug intoxication was excluded, a transfer to a psychiatric unit was considered. Simultaneously, short stenosis of the left posterior cerebral artery was diagnosed with the use of computed tomography angiography. Magnetic resonance imaging revealed bilateral acute ischemia of the medial parts of the thalamus, and immediate thrombolysis and thrombectomy treatment was initiated. Both procedures were successful and the patient was discharged in good general condition. COMMENT: Psychomotor agitation may be an atypical manifestation of a bilateral thalamic ischemia. This may lead to misdiagnosis and reduce the likelihood of proper treatment.