Case Report: Psychiatric comorbidity in the setting of encephalomalacia and gliosis

Background: We report a case of an adult female with a history of multifocal encephalomalacia and gliosis following multiple strokes confirmed by magnetic resonance imaging, who presented with neuropsychiatric symptomatology. Encephalomalacia and gliosis of the brain are pathological changes in brain tissue associated with cerebral vascular and traumatic injury, and can present with a variety of symptoms ranging from cognitive decline to psychosis. Neurological manifestations following a stroke are well-documented, but there are few reports of adults with psychiatric symptomatology in the setting of encephalomalacia and gliosis in the caudate nucleus following stroke. Herein we discuss the psychiatric symptom profile and management associated with this lesion, while emphasizing the importance of brain imaging to gain a deeper understanding of its correlation with psychiatric manifestations. Case presentation A 64-year-old female with a history of multiple strokes and psychiatric history of generalized anxiety disorder was admitted to an inpatient psychiatry unit due to a 3-month history of worsening anxiety, depression, and functioning. Brain imaging revealed a new-onset focus of encephalomalacia and gliosis of the body of the left caudate, consistent with a transient ischemic attack diagnosed 3–4 months prior to psychiatric hospitalization. While admitted, the patient was treated with risperidone, sertraline, trazodone, gabapentin, and lorazepam with improvement in symptoms of anxiety, mood, and functioning. Conclusions Brain imaging in psychiatry is typically used to differentiate organic or structural causes of psychiatric symptoms from functional disorders, but lesions in specific areas of the brain and their clinical correlates are not well-characterized. This case in particular provides support for the involvement of the caudate nucleus in the development of neuropsychiatric symptoms, and is important for understanding the psychopathology of neuropsychiatric disorders with potential to guide treatment for these patients.