A case of autoimmune autonomic ganglionopathy with prolonged delirium

Asian J Psychiatr. 2019 Jan:39:8-9. doi: 10.1016/j.ajp.2018.11.003. Epub 2018 Nov 13.

Abstract

Autoimmune autonomic ganglionopathy (AAG) is a rare acquired immune-mediated disorder that leads to autonomic failure. It is sometimes complicated by mental and behavioral symptoms. We report a case of 72-year-old male with AAG who was admitted to the psychiatric department for prolonged severe delirium. Repeated loss of consciousness attributed to severe orthostatic hypotension disturbed recovery from delirium. In addition, intracerebral hemorrhage occurred during hospitalization, and this cerebrovascular event may have been substantially affected by unstable blood pressure due to AAG. This case suggests importance of differential diagnosis of AAG in patients with mental and behavioral symptoms accompanying severe autonomic failure.

Keywords: Autoimmune autonomic ganglionopathy; Autonomic failure; Delirium; Elderly; Ganglionic nicotinic acetylcholine receptor autoantibody.

Publication types

  • Case Reports

MeSH terms

  • Adrenergic alpha-Antagonists / therapeutic use
  • Aged
  • Antipsychotic Agents / therapeutic use
  • Autoimmune Diseases / complications*
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / drug therapy
  • Autonomic Nervous System Diseases / complications*
  • Autonomic Nervous System Diseases / diagnosis*
  • Autonomic Nervous System Diseases / drug therapy
  • Brain / diagnostic imaging
  • Brain / physiology
  • Delirium / complications*
  • Delirium / drug therapy
  • Diagnosis, Differential
  • Electroencephalography
  • Humans
  • Immunoglobulins / therapeutic use
  • Indenes / therapeutic use
  • Magnetic Resonance Imaging
  • Male
  • Mianserin / therapeutic use
  • Risperidone / therapeutic use
  • Time
  • Tomography, X-Ray Computed

Substances

  • Adrenergic alpha-Antagonists
  • Antipsychotic Agents
  • Immunoglobulins
  • Indenes
  • Mianserin
  • ramelteon
  • Risperidone