Case Report

Starvation Causes Acute Psychosis Due to Anterior Thalamic Infarction

Authors: Manoj Mittal, MBBS, Saud Khan, MD

Abstract

A 19-year-old female presented with acute onset of bizarre behavior, confusion, auditory hallucinations, and delusions after two weeks on a 100 kcal/day diet. She had a normal neurological examination. Urinalysis showed ketones 4+. She had elevated antinuclear antibody (ANA) (320) and positive heterozygous factor V Leiden mutation. Magnetic resonance imaging brain scan showed hyperintensity in the ventroanterior nucleus of the left thalamus. Ventroanterior thalamic stroke has been associated with personality changes. This is the first case of starvation-induced thalamic psychosis in the setting of factor V Leiden mutation and elevated ANA. The patient improved with risperidone in one month.


Key Points


* Starvation can cause ketoacidosis.


* Ketoacidosis can cause dehydration and hyperviscosity.


* Factor V Leiden deficiency along with ketoacidosis can cause stroke.


* Thalamic stroke can present as psychosis.

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