A Rare Presentation of Attention Defcit/Hyperactivity Disorder A recommendation to be more alert!
Journal Title: Sultan Qaboos University Medical Journal - Year 2010, Vol 10, Issue 1
Abstract
We report the case of a 7 year-old Omani girl with tuberous sclerosis (TS), attention defcit hyperactivity disorder (ADHD) and bipolar disorder (BD), at Sultan Qaboos University Hospital (SQUH), Oman. For a year she had been suffering from hyperactivity, aggression, over talkativeness, insomnia, risk-taking behaviour, distractibility, poor attention and seizures. Tis clinical picture evolved slowly, but was progressive in nature. Before the consultation at her local health centre, she was given four drugs without being properly investigated; she continued to deteriorate. In SQUH, she showed hyperactive-impulsive behaviour, elation, flight of ideas, preoccupation with self and high self-confdence. Te physical examination revealed multiple hypomelanotic patches all over the body and a shagreen patch at the sacral area. Te electroencephalogram showed generalised epileptic discharges, while brain imaging showed multiple parenchymal calcifed foci in both cerebral hemispheres. Other investigations were normal. She was given valproate, and then a psychostimulant, methylphenidate, that controlled her state. Our aim in reporting this case is not only because it is unique, given its rare comorbidity (ADHD, TS and BD), but also to remind our junior colleagues to be alert to the possibility of an underlying neuropathology when performing clinical examinations and investigations of children presenting with neuropsychiatric symptoms.
Authors and Affiliations
Marwan Al-Sharbati| Departments of Behavioral Medicine, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman, Rashid Al-Zaidi| Departments of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman, Rahma Al-Naamani| Departments of Behavioral Medicine, Sultan Qaboos University Hospital, Muscat, Oman, Amna Al-Futaisi| Departments of Child Health, Sultan Qaboos University Hospital, Muscat, Oman, Rajeev Jain| Departments of Radiology College of Medicine and Health Sciences, Sultan Qaboos University, Muscat
Keywords
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