Blog

A 22-year-old man was brought to the emergency department (E…

A 22-year-old man was brought to the emergency department (ED) by law enforcement for odd behavior. He was observed “running through the streets yelling that he was God,” prompting a neighbor to call the police. Upon initial evaluation, patient is largely uncooperative with the interview, answering most questions with further questions and demands to be “released immediately to fulfill the prophecy, my people are waiting.” He denies any drug use, saying he “needs to stay pure.” Pulse is 95/min, respirations 15/min, blood pressure is 130/75 mmHg, and temperature is 98.5 degrees F. On mental status exam, patient is alert and oriented all spheres, other than reporting that his name is “the Truth.” He reports his mood as “wonderful,” and his affect is noted to be euphoric and labile. His speech is loud and pressured. His thought process is tangential and disorganized. Medical workup was unremarkable; a urine drug screen was negative. Collateral information is obtained from the patient’s mother. She states that the patient is a college student who lives at home and has generally been in good health, but that the patient has been acting oddly for the past five days. She tries to give him privacy at home but believes he has been up most nights writing notes and reading the bible. She states that the patient has changed his major twice over the past 5 days, has written out several screenplays for production, and he has stated that he’s “in talks with Will Smith” to play him when his movie comes out. She denies knowledge of recreational drug use by the patient. Which of the following is the most likely diagnosis?

A 38-year-old man is brought to his primary care physician a…

A 38-year-old man is brought to his primary care physician at the urging of his wife due to a personality change over the past 5 months. The patient denies having any current concerns, but his wife reports that he has become more irritable, impulsive, and has started making sexually inappropriate comments to underage family members. She informs you that the patient’s father had similar symptoms starting at 42 years old. Physical examination is notable for involuntary movements of the tongue. He has a sudden involuntary jerking movement of the upper extremity that he attempts to hide by straightening his glasses. Which of the following regions of the brain is most likely affected?