Abstract

Introduction:

Schizophrenia affects between 0.6% and 1.9% of the US population. The overwhelming majority of diagnoses occur in the 2nd and early 3rd decade of life and 85% of all cases are diagnosed before the 4th decade. Late-onset schizophrenia (LOS) is defined as the onset of schizophrenia between the ages of 40 and 60. Up until 1987, the diagnosis of schizophrenia could only be applied to patients with symptom onset before the age of 45. Despite the removal of this upper age limit, the diagnosis of schizophrenia in individuals later in life is often overlooked and underappreciated.

Case presentation

We present the case of a 58-year-old male with no known psychiatric history who presented to the emergency department involuntarily for bizarre behavior. The patient was experiencing persecutory delusions and auditory hallucinations for 6 months, which started 2 months after a hemorrhagic stroke involving the basal ganglia. According to the patient’s wife, he had no psychiatric issues until the incident.

Discussion

Neuropsychiatric symptoms following stroke occur in 30% of stroke survivors. Psychiatric symptoms are often underdetected after stroke possibly due to the functional impairments that accompany neurological injury. Delusional disorder is the most common diagnosis reported, followed by schizophrenia and mood disorders with psychotic features. Studies have demonstrated abnormalities in the caudate nucleus in schizophrenia and traumatic events have long been understood to be drivers in the development of schizophrenia. In this case, neurological injury secondary to hemorrhagic stroke involving the caudate nucleus incited LOS in a male with no psychiatric history.