Louisiana Research Day Program Book 2025

Case Studies: Section 1

Case Studies: Section 1

Naqiya Ujjainwala, OMS-III; Ashlynn Calk, OMS-III; Derrick Fokala, OMS-III; Karson Munson, OMS-III; Suresh Sabbenahalli, MD VCOM-Louisiana; Brentwood Hospital of Shreveport, LA 88 PERSONALITY CHANGES POST FRONTAL LOBECTOMY FOR EPILEPSY

Sydney Boudreaux, OMS-III 1 ; Justin Nguyen, OMS-III 2 1 VCOM-Louisiana; 2 Department of Obstetrics and Gynecology, Opelousas General Health, Opelousas, LA 89 DUAL THERAPY APPROACH TO CERVICAL ECTOPIC PREGNANCY-A CASE REPORT

Context: Frontal lobectomies or frontal lobe resections (FLR) can be considered for medication-resistant frontal lobe epilepsy; however, there must be a thorough deliberation process with the medical team and patient before taking this step as there can be lasting cognitive side effects. Our frontal lobes are imperative for executive functions such as planning, decision-making, and most importantly, in this case, behavior regulation. The removal of a specific frontal lobe area may help with reducing seizures, but it may also cause everlasting personality changes that could mimic or lend to other psychiatric disorders like depression, mania, bipolar, OCD, and/or schizophrenia. Report of Case: A 38-year-old Caucasian female presented to the psychiatric hospital with a medical history of chronic back pain, recent hyponatremia, epilepsy, depression, and anxiety. She was put on an emergency commitment for a recent suicidal attempt when she attempted to jump out of her car. Her husband reported to the emergency room that the patient attempted to jump out of a moving car which he understood to be a self-harm

attempt. During the psychiatric evaluation, the patient was very talkative with significant mood lability and frequent loose associations requiring redirection during the conversation. She also asked questions repeatedly even after being given explanations a few times. The patient had loose association and flight of ideas at times with frequent manic symptoms, pressured and rapid speech, endorsed irritability, impulsivity, and easily getting distracted. When speaking to the patient’s husband, he reports that she frequently engages in risky behavior like sexual encounters and other episodes where she goes ballistic and cannot reason or control herself. The patient denied current SI/HI/AVH but appeared to be minimizing during intake and throughout her hospital course and progress evaluations. At the time of assessment, her thought process was tangential, and her thought content contained a recent suicidal ideation and attempt, which the patient denies at the time of assessment. Her insight and judgment were limited. Our psychiatric diagnoses are 1. bipolar and related disorder, due to another medical condition (R-sided frontal lobectomy) and 2. bipolar I disorder, current manic episode without psychotic features. Our plan is currently

to manage the patient with medications for her mood and seizures.

Context/Impact: Cervical pregnancies are a rare type of ectopic pregnancy, representing less than 1% of all ectopic pregnancies. We present a case of early diagnosed cervical ectopic pregnancy in which combined methotrexate and uterine artery embolization was utilized to terminate a cervical pregnancy successfully. This case provides another perspective that can aid in advancing more cautious treatment strategies that prioritize patient well-being while reducing potential risks. Report of Case: A 37-year-old female, gravida 3 para 1-0-1-1, initially presented for a pregnancy ultrasound due to bleeding. Based on her last menstrual period, she was estimated to be 7 weeks, 2 days pregnant. The patient reported experiencing intermittent bleeding over the past week, initially without cramping. This symptom diminished over time. Initial ultrasound images were concerned about a potential cervical pregnancy, as the pregnancy was likely located in the lower uterine segment near the cervix. Additional diagnostic imaging was recommended, and she was referred to a maternal-fetal medicine specialist for a follow

up ultrasound and further evaluation. Upon referral visit, extensive imaging was conducted, including transabdominal and transvaginal obstetric ultrasound. The ultrasound revealed a gestational sac and yolk sac, with a crown rump length (CRL) of 11.1 mm, consistent with 7 weeks and 1 day of gestation, and a fetal heart rate (FHR) of 145 bpm. The gestational sac was located abnormally near the cervical scar area. The uterus appeared normal, but the right and left ovaries had suboptimal visualization. An empty uterine cavity was observed, with the gestational sac seen near a previous C-section scar in the cervical area, not reaching the endometrial cavity. Findings were suggestive of an ectopic pregnancy in the C-section scar/cervical area, with positive cardiac activity. Termination of the pregnancy was suggested via uterine artery embolization and methotrexate injection, to which the patient agreed. With hysterectomy being a secondary option in case of failure, the patient agreed to the proposed treatment plan, and it was initiated. Serial quantitative beta-hCG levels and ultrasounds were obtained throughout the therapy period, and the serum marker and size of ectopic decreased weekly.

Comments/Conclusion: This case scenario underscores the significance of detecting ectopic pregnancies and using a collaborative approach to managing them effectively early in pregnancy. Cervical ectopic pregnancies lack established conventional treatment approaches that require personalized care based on patient preferences. Such cases offer insights that can assist healthcare providers and researchers refine treatment methods and enhancing results. Non-invasive treatments like methotrexate combined with uterine artery embolization show promise in delivering outcomes for patients seeking to preserve fertility while reducing the risks linked to procedures such as hysterectomy. This particular scenario offers perspectives that can aid in advancing more cautious treatment strategies that prioritize patient well-being while reducing potential risks.

Conclusion: In our patient, it is difficult to prove causality between her bipolar symptoms and her past surgical history as we were not there to conduct any assessments pre- and post-procedure. However, patients with frontal lobectomies can develop positive and negative mood changes which can affect the quality of life and patient safety. Therefore, psychiatric assessments and medication management with regular follow-ups are necessary post procedure. If a frontal lobectomy is the best option for a patient’s epilepsy, then evaluations must be in place to gauge personality changes to protect patients and others in instances where mania or depressive symptoms may occur. In this patient’s case, we aim to mitigate her bipolar and seizure symptoms through medication management and updating the treatment plan as needed. We have already seen an improvement in her symptoms on the current treatment plan.

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