EPA-0528 - Impulse control disorder due to hypothalamic hamartoma - a case report

Abstract

Introduction:Hypothalamic Hamarthoma (HH) is a non-neoplastic nodule resembling the normal gray matter of the hypothalamus. It is usually recognized by its characteristic’gelastic seizures’ and central-type precocious puberty. However, detection of HH in institucionalized people with anti-social and violent behavior has laid some attention in its psychiatric manifestations.Objective:The authors intend to report a clinical case of a patient with rage attacks who was diagnosed with HH, and to make a review of psychiatric symptoms and their treatment in this disorder.Methods:Literature review through Pubmed and report of a clinical case.Results:Patient aged 39 years old with a 10-year history of epilepsy, under levetiracetam 1000 mg id, was referred to Psychiatry consult due to episodic rage attacks with physical violence. During the diagnostic investigation, the patient made a Magnetic Resonance Imaging which detected a 1cm non pedunculated HH in the III ventricle. The patient Mental State Examination was positive for mild cognitive decline and impulse control disorder with immediate regret and insight. The latter disorder was stabilized with quetiapine 300 mg SR bid and antiepileptic therapy.Discussion and Conclusion:This review shows the importance of Magnetic Resonance Imaging in characterization of some psychiatric syndromes. The behavioural abnormalities in patients with HH have not been specifically studied, although typical or atypical antipsychotics plus antiepileptic drugs have a favorable impact. However, aggressiveness is in most cases medically intractable and even with surgery, it can persist at a minor degree.