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Acute viral infection encephalopathy linked to organic personality disorder

Nikola Tsonev, Nora Ivanova, Vanesa Dodova, Raya Dimitrova


Introduction: Encephalopathy is a structural and/or functional disorder of the brain with multiple causes, one of them being acute viral infection. It is clinically presented with a variety of neurologi­cal and psychiatric symptoms - muscle weakness, poor concentration, seizures, changes in personal­ity, as well as lethargy or psychosis.

Materials and methods: A 12-year-old patient is being presented, hospitalized in the past due to viral encephalitis. Symptoms included fever, nausea, drowsiness, apathy and confusion. A lumbar punc­ture was performed at the time with no pathogens found in the cerebrospinal fluid. After a psychi­atric assessment through an interview the patient was diagnosed with organic personality disorder. Therapy was conducted and after the full resolution of the patient`s condition he was discharged. An year and a half later a relapse of previous symptomatology occurred. The boy was hospitalized again in a psychosis-like state after an interview with a psychiatrist.

Results: Beginning with fever the second episode included visual hallucinations, photophobia and disorientation, psychosis-like beliefs - believing his mother is not real (Capgras syndrome). Although fully managing the first episode a therapy with Aripiprazole and Finlepsin only lead to a partial im­provement and fluctuation of the condition during the relapse. A follow up and additional examina­tions were commissioned.

Conclusion: Even though long term complications are rare the condition should be treated with care. Neuropsychiatric symptoms are common in the acute phase of viral encephalitis. In rare cas­es they may also reappear after recovery, especially in children. Symptoms may present as psychosis (35%), catatonia (33%), psychotic depression (16%), and mania (11%). Post-infectious structural and functional changes in the brain may lead to personality shifts, e.g. detachment from reality and dis­inhibited behaviour resulting in long-term disability and social isolation of the patient. Psychiatric consultation and follow-up should be requested for patients at risk without hesitation.


viral encephalitis; organic personality disorder



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