La importancia de descartar patología orgánica en la psiquiatría de urgencias.

espanolObjetivo La clinica psiquiatrica puede ser expresion de multiples patologias somaticas. Es necesario valorar la importancia de la historia clinica y de las pruebas complementarias pertinentes para realizar un abordaje adecuado. Caso clinico Varon de 53 anos que acude al Servicio de Urgencias con clinica abrupta consistente en fobias de impulsion, irritabilidad y agresividad verbal. La impresion diagnostica es de trastorno adaptativo y rasgos anancasticos de personalidad. Al dia siguiente acude de nuevo, con clinica confuso-delirante y hemiplejia izquierda. Se realiza TAC cerebral con el hallazgo de un infarto subagudo parietotemporal. Resultados Los «accidentes cerebrovasculares no obvios» o «infartos camaleon» se definen como ictus con principal expresion clinica psiquiatrica. Su aparicion aguda es escasa y presentan un mayor error diagnostico. Conclusiones Este caso presenta un proceso neurologico de forma atipica. Consideramos relevante la reflexion sobre la importancia de la etiologia de la «descompensacion psicopatologica aguda» en el servicio de urgencias. EnglishObjective On some occasions, diverse somatic pathologies can present relevant psychiatric clinical features. However, the etiology of the disease may not be due to psychiatric disorder, but both to organic and neurological causes. Thus, for proper diagnosis of the disease, evaluation of the importance of the clinical history, as well as supplementary tests, is required. Clinical case A 53-years-old man is admitted to the Emergency Room, presenting abrupt psychiatric clinical features: impulsive phobias, irritability, and verbal aggression. The patient is diagnosed with adjustment disorder with obsessive personality traits. The next day, the patient returns to the Emergency Room. He is diagnosed with confused-delusional clinic and left hemiplegia, and underwent a CT scan. Sub-acute parietal-temporal stroke was found. Results The term “non-obvious cerebrovascular accident” or “stroke chameleon” has been coined to the stroke with a main clinical psychiatric expression. Literature about this type of acute onset stroke is scarce and they could present a major misdiagnosis. Conclusions This case report highlights a neurological process with an atypical form. Great importance of the reflection of the etiology of “acute psychopathological decompensation” should be given.