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A Case of Acute Demyelinating Encephalitis Presenting as Manic Symptoms
Omopariola Adegbola, M.D.; Nahla Mahgoub, M.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:E17-E18. doi:10.1176/appi.neuropsych.13010003
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The authors have no direct financial interests in the subject materials discussed in the article.

Geriatric Psychiatry Fellow

Assistant Professor of Psychiatry
Weill Medical College of Cornell University, Westchester Division
White Plains, NY

Correspondence: Dr. Mahgoub; e-mail: namd06@aol.com and nam2024@med.cornell.edu

Copyright © 2014 by the American Psychiatric Association


To the Editor: Differentiating a manic episode of bipolar disorder from mania secondary to a medical condition in older adults is challenging. The diagnostic dilemma appears when the patient has an established diagnosis of bipolar disorder from a young age. The neuropsychiatric manifestations are similar, and there have been numerous conditions to which secondary mania can be attributed. A thorough differential diagnosis should be considered to help guide appropriate management. Evidence suggests that neurological conditions are the most common causes of secondary mania. In a retrospective study examining 50 manic patients older than age 65, neurological disorders were reported in 74% of the patients.1 We summarize a case of mania that emerged in the context of acute demyelinating encephalitis in an elderly patient with a diagnosis of bipolar disorder since adolescence.

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