LATE-ONSET PSYCHIATRIC MANIFESTATIONS OF ENCEPHALOMALACIA AND GLIOSIS WITH UNCERTAIN ETIOLOGY

Background: Encephalomalacia refers to the loss of brain tissue resulting from liquefactive necrosis, which can occur due to a variety of insults including trauma, infarction, infection, or haemorrhage. This process may also lead to gliosis, and such changes are typically evident on CT or MRI scans, which remain the primary diagnostic modalities. Clinical presentation varies depending on the location and extent of brain involvement, ranging from seizures and focal neurological deficits to psychiatric manifestations, as observed in this case. Chronic encephalomalacia is most commonly associated with hypoxic injury sustained during birth or infancy, but when presenting later in life with isolated psychiatric symptoms, it can pose a significant diagnostic challenge. This case highlights the importance of considering underlying organic causes in psychiatric presentations and emphasizes a thorough diagnostic approach prior to initiating treatment.

Case Report: We present the case of a 21-year-old female who presented to the clinic with symptoms of depressed mood and bizarre questioning. She had a longstanding history of intellectual and cognitive delays that had not been thoroughly investigated. Further history from the family revealed a significant perinatal background, including premature birth at 32 weeks and delayed crying at birth, suggesting possible early hypoxic insult. An incidental diagnosis of encephalomalacia was made approximately one and a half years prior during neuroimaging conducted after an accidental fall. The patient also had a history of congenital esophageal atresia, surgically corrected at the age of nine. However, she continued to experience difficulty swallowing solid substances, including oral medications, which posed challenges in determining an appropriate treatment plan. Ultimately, she was managed with long-acting injectable Aripiprazole, in addition to Escitalopram and Benztropine.

Conclusions: This case highlights a rare psychiatric presentation of chronic encephalomalacia. It underscores the importance of early neuroimaging in patients with atypical or treatment-resistant psychiatric symptoms, especially when accompanied by developmental delays. Timely identification of organic causes can prevent diagnostic delays and guide appropriate, individualized management. Further research is warranted to better understand adult psychiatric manifestations of encephalomalacia and optimize care strategies.