The Grapevine

Brief Psychotic Attack: The Medical Condition That Led A Woman To Accuse Her Husband Of Cheating

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A woman became paranoid, accusing her husband of infidelity, as a result of porencephaly, a rare disorder. Dimitar Dilkoff, Getty Images

Irmak (not her real name) received a call from the school and, hearing the details of her daughter’s poor academic performance, felt her own life beginning to unravel. It made no sense that her daughter, who had always been an adequate if not shining student (much like herself), might suddenly fail and be forced to change schools. Could her own 20-year marriage, also adequate until now, be in jeopardy as well?

At dinner, the normally placid Irmak, 43, snapped at her daughter and started an argument with her husband about the sausages. That night, Irmak couldn’t sleep. Gripped by a sudden conviction, she left the bed and searched first the pockets of her husband’s pants and coat and then his phone. Not sure exactly what she was looking for, she knew she’d eventually find some clue of his infidelity. When her husband found her the next morning, a bleary-eyed Irmak insisted, “Where’s your mistress? I know you’ve hidden her somewhere!”

And so researchers at Istanbul’s Uskudar University present the case of a Turkish woman experiencing a most unusual kind of attack for no apparent or at least no obvious reason.

“The patient had no previous psychiatric or neurological history. She had no drug and no family psychiatric history,” wrote the authors, noting as well her anxiety and suspicions, the paranoid delusions she had about her family.

After a series of tests, it was clear she suffered only from anemia, as her physical symptoms were otherwise normal. With no pathology detected in the EEG and ECG scans, the doctors conducted a brain scan.

Finally, the truth: the MRI detected a porencephalic cyst in the frontal lobe of her brain.

Porencephaly is a rare disorder of the central nervous system and involves a cyst or a cavity filled with cerebrospinal fluid in the brain’s parenchyma (functional tissue). While cysts may be congenital or acquired, they may be due to a number of causes including hemorrhage, local damage from stroke, or traumatic brain injuries. Babies born with porencephalic cysts are usually diagnosed by their first birthday, the National Institute of Neurological Disorders and Stroke (NINDS) indicates, and only some live past age 20.

Depending on where the cyst is located, their effects can include seizures, mental retardation, learning disability, or psychiatric symptoms.  Reports of porencephaly leading to psychosis are extremely rare, the researchers note, though in the case of the Turkish woman, the presence of the cyst in the right frontal lobe might explain the reason she broke down under stress and became paranoid and psychotic.

Normally, treatment includes physical therapy, medication for seizures, and the placement of a shunt in the brain to remove excess fluid, according to NINDS.  Because it was impossible to safely remove the woman's cyst through surgery, the doctors prescribed an anti-psychotic drug instead. Most likely, the woman will take the drug for the remainder of her life. The patient is doing very well with no symptoms of psychosis. Her doctors believe she will be free of any further psychotic attacks in the future.

Source: Noyan OC, Salcini C, Tau BS, Eryilmaz G. Porencephalic cyst and late onset brief psychotic disorder. BMJ Case Reports. 2016.

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