Since Bell's original description delirious mania (DM) has been repeatedly rediscovered and renamed, resulting in much confusion as to its meaning.Definitions range from mania with self-limited temporalspatial disorientation to a fatal, delirious catatonic syndrome with euphoric mood, high fever and autonomic instability. Moreover, it remains unclear whether DM is a specific clinical entity or an unspecific, unpredictable complication of mania, and whether it is a useful diagnostic category. Objective: To identify the frequency and clinical features of DM and mania with delirium. Methods: We reviewed all admissions to our acute inpatient unit with mania, hypomania or mixed affective state, in 2006 and 2007. Cases with delirious features and cases with a working diagnosis of DM, were reviewed in detail. The three groups (no delirium, delirious features and DM) were compared for general demographic and clinical variables, as well as features specifically associated with DM (e.g., catatonia; nakedness; inappropriate toileting; unexplained fever, etc). Results: We found 100 patients with mania, hippomania or mixed affective state. 14 had medically unexplained delirium, 4 of them with a final diagnosis of DM. DM cases (but not non-DM mania cases with delirious features) had extremely long durations of stay, acute onset, hypertermia, catatonia, autonomic instability, anarchic sleep, shouting/coprolalia, delirium persisting for over a week, and were more likely to receive ECT. Moreover, in three of them DM occurred in most manic/mixed affective episodes. Conclusion: DM is a rare occurrence in bipolar disorder. It has typical clinical features and may be recurrent.

Highlights Cerebellopontine angle hemangioblastoma is a rare condition. Magnetic resonance imaging evaluation is important for the differential diagnosis of hemangioblastoma. Surgical planning in hemangioblastoma surgery is a central key point.

Catatonia is a neuropsychiatric syndrome characterized by a combination of disturbed motor functioning and changes in thought, mood and vigilance. Two patterns - one consisting in catalepsy, posturing, mutism and negativism and a second consisting of echophenomenon, automatic obedience, verbigeration, and other stereotypies - have been abstracted. Catatonia has been associated with psychiatric disorders - schizophrenia and bipolar disorder for example - as well as secondary to various underlying medical conditions.It will be described a case report of a 55 years old woman with prior psychiatric history of hospitalization with an unspecified nonorganic psychosis (F29-ICD10), presenting features of catatonia - immobility with fixed posture and gaze (sometimes presenting posturing), an almost absence of spontaneous movements and speech, echophenomenon (echolalia, palilalia, coprolalia) erupting in a otherwise mute state and showing, on occasions, periods of purposelessness motor excitement and restlessness, verbigeration and screaming with a grim of terror. She was disoriented and performed poorly on the MMSE. No neurologic focal signs were disclosed other than prominent primitive reflexes. Prior to admission, her family reported a sudden mood change: she became irritable, argumentative, with delusional thought content of persecutory nature, grandiose ideas. Viral and immune-mediated encephalitis were discharged. The MRI scan showed a right temporal medial lesion (amygdala atrophy). It will be addressed the hypothetical relationship between the dramatic clinical presentation and the cerebral lesion, grounded on the scientific research regarding limbic encephalitis, catatonic symptoms and neurophysiology. It will also be underscored the clinical relevance of differentiated psychopathology of catatonia.