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Current literature shows very few case reports about manic symptoms arising in patients with arteriovenous malformations and no other predisposing factors, where these cases presented with mania before the initiation of treatment. We report a rare case of a 46-year-old male patient, with a history of a left arteriovenous malformation (AVM) status post radiation treatment with associated seizures, who presented to the emergency department of a local hospital with acute mania and other behavioral changes. The patient had manic symptoms, including mood lability, impulsivity, insomnia, decreased appetite, jealous delusions, pressured speech, and suicidal ideations. The patient's escitalopram dose for depression was reduced from 20 mg to 10 mg, and valproate was started during admission. After a three-day hospital admission, his psychiatric symptoms gradually improved. He was subsequently discharged home with additional instructions to follow up with his neurologist. In this case report, we show that organic manic disorder should be considered in any manic patient who presents outside the usual age of onset for idiopathic manic-depressive disease, lacks a family or personal history of affective disturbance, or exhibits concomitant neurologic deficits. In addition, we emphasize that distinguishing between primary psychiatric conditions and those secondary to medical causes for patients who present with acute mania can significantly impact the care a patient receives and can make a difference in their psychiatric and medical prognosis.
Villa et al. (Mon,) studied this question.