The Successful Use of Electroconvulsive Therapy in a Patient With Cerebral Aneurysms and a Pituitary Lesion

Abstract

To the Editor Electroconvulsive therapy (ECT) remains one of the most effective treatments in the current psychiatric armamentarium yet recent reports highlight widespread underutilization despite its excellent safety profile. 1 Here, we seek to add to the growing list of case series of the safety of ECT use in patients with history of significant intracranial pathology. Ms. D is a 52-year-old woman with a history of recurrent, severe major depressive disorder with psychotic features admitted to our inpatient service for consideration of ECT with worsening psychosis and catatonic symptoms despite several psychotropic trials. In the year preceding admission, the patient had one additional hospitalization following a suicide attempt via cyclobenzaprine overdose. Her past medical history is notable for Hashimoto's thyroiditis, hypertension, a non-functional pituitary lesion (microadenoma vs. cyst), and two cerebral aneurysms diagnosed in 2012 on MRI/MRA as part of a workup for chronic migraine headaches. The 4×5×7-mm aneurysm at the trifurcation of the right middle cerebral artery (MCA) was successfully clipped in 2012 and the second aneurysm 1-mm from the M1 segment of the left MCA did not receive intervention. Since neurovascular intervention, the patient had received annual follow-up including serial neuroimaging without interval progression of aneurysms or the pituitary lesion described as a "hypoenhancing 5×6.6×5-mm left pituitary lobe lesion." Upon admission, clinical evaluation was for significant psychomotor slowing, minimal oral intake, perseveration, insomnia, and auditory hallucinations associated with depressed mood and suicidal thoughts. Despite documented history of hypertension, her blood pressure (BP) remained normotensive (range 98/69-122/93 mmHg) with mild tachycardia (heart rate, range 82-107 beats per minute) throughout inpatient admission without antihypertensive agents. Laboratory assessments were notable for an abnormal dexamethasone (1 mg) suppression test (DST, Cortisol 08:00 = 15.1 µg/dL, Cortisol 16:00 = 9.2 µg/dL), but otherwise unremarkable. Initial treatment included a benzodiazepine challenge for catatonia

Electroconvulsive Therapy in Patients With Cerebral Aneurysms

“…The highest peak blood pressure was reported by Drop et al, 8 who reported a blood pressure peak of 340 mm Hg. The lowest peak blood pressure was 122 mm Hg 11 . Three articles did not report this parameter.…”

“…The lowest peak blood pressure was 122 mm Hg. 11 Three articles did not report this parameter. The average blood pressure where recorded was 186.6 mm Hg systolic.…”