Chronic subdural haematoma presenting as late onset psychosis

ABSTRACT

This case report highlights a case of late onset psychosis which was an uncommon occurrence to psychiatric services in developing countries. Medical causes of late onset psychosis, though known, are often missed. Chronic subdural haematoma (CSDH) is predominantly a disease of the elderly. A history of direct trauma to the head is usually absent. Methods: A previously healthy 80-year-old male presented with 4 months duration of late onset psychosis. Result: Neurological examination was normal. Routine investigations were within normal limits and MRI brain revealed a chronic subdural haematoma. Owing to his age and small size of the haematoma, patient was not operated on and showed improvement with the pharmacologic treatment for psychosis. Conclusion: Detailed longitudinal history, clinical examination, investigations along with high index of suspicion is necessary to effectively manage this condition. As CSDH is known as a great imitator and is usually a disease of the elderly, it should be kept in mind while dealing with cases of late onset psychosis.