Disclosures: Neil G. Knight, MD: No financial relationships or conflicts of interest

Case Description: This patient sustained a TBI with depressed left fronto-temporal bone fracture and C2 hangman’s fracture from a motor vehicle accident. Initially sequelae included memory, cognition with eventual relative return to baseline , where she was running a soup kitchen and handling its finances. She had a major move home 23 years after her initial injury where she developed psychosis with delusions and auditory hallucinations . She was admitted to a community inpatient psychiatric hospital where she failed multiple antipsychotic and mood stabilizing medications. She was admitted to an academic psychiatric hospital and improved on an antipsychotic medication and sleep-wake-cycle regulation

Setting: Academic Tertiary Medical Center

Patient: A 60-year-old female with remote Traumatic Brain Injury (TBI) Assessment/

Results: She had full work-up to rule out other causes of psychosis including seizures, metabolic disturbances, toxins, dementia which were all negative. She presented with the typical features of psychosis after TBI: auditory hallucinations, delusions, absence of negative symptoms, injury to frontal or temporal lobes. MRI showed chronic encephalomalacia at the anterior inferior left frontal lobe. She would have return of symptoms if she were attempted to be weaned off her antipsychotic, sleep-wake-cycle disturbances, or a major life stressor occurred.

Discussion: This is a rare case of psychosis 20 years after initial TBI. Psychosis is a known sequela of TBI. A majority of case reports report average age of onset 20-30 years of age. Studies differ on when the majority of cases occur, but the average is around 4-5 years. Many are reported to occur around 1 year after injury. To the best of our knowledge there are no reported cases of psychosis greater than 15 years after injury.

Conclusion: Mood instability and psychosis can be a late effect of traumatic brain injury and can present much later than is documented in the literature

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/latent-psychosis-after-traumatic-brain-injury-a-case-report/