I had a patient who for many years was followed up under a diagnosis of bipolar (manic-depressive) disease. He was 32 years old and came from a village in Central Anatolia. He wanted that I too would assess him.
He told me his story: he had manic episodes during which he was very cheerful, spent too much money, had an increased libido, helped people around him, believed that he was a very important person, had accelerated association of ideas and talked a lot. These episodes were followed by episodes during which the exact opposite was the case. During these depressive episodes he felt worn out, his self confidence level dropped, he spoke of suicide, and did not want to talk …
When he came to me he was in a manic episode. His level of self care had dropped. Psychomotor activities had increased, in other words he was unable to stand still for any length of time. Associations of ideas were fast and disconnected. It was clear that he could not control the speed of his thoughts. The content of his thoughts partially consisted of major delusions.
In short, it was a bipolar case that would have easily been diagnosed by any ordinary specialist or even by a first year assistant.
However, there was something about him that concerned me. I was unable to understand the reason for the flushing of his face, the pupillary dilatation, and the frighteningly penetrating, fixed stare in his eyes. Neurological examination revealed no pathology.
In those years MR was not available. I asked for a BT which showed normal results. I shared the subject with my friends, we had a consultation, and everyone was of the opinion that I should not dwell on the subject any further. But I was still not at ease. I asked for a second BT from the same centre, accompanied by a letter in which I expressed my suspicions. I cannot forget the close cooperation from the relatives of the patient. Only they supported me. And the result was, that an ischemic area (starved of blood) 5 mm in diameter was found in the brain… The area in question contained the cores which operated the emotional states.
Finally more advanced investigation showed that the patient had an aneurysm in his ascending main artery (aorta) and associated with this a blood clot which we call thrombus.
His relatives were workers in Germany. They took the patient to Germany. Unfortunately I lost track of him lateron.
As I did not have the opportunity to ask for their permission, the case was never published in a scientific journal.