Qalandar KASNAZAN, Osama Shukir Muhammed AMİN, Karzan SEERWAN, Hiwa Abu BAKİR, Bakhtiar FAYAK, Hiza Qalandar HUSSEİN

Şüpheli Davranış ve Kişisel Değişimler ile Karışık Kısmi Epilepsinin Yanlış Teşhisi

Pankreatik insülinom nadir görülen endokrin tümörü olup teşhisi ciddi anlamda yüksek şüphe gerektirmektedir. Hastaların çoğuna son aşamada gözlenen tümör bulgusundan önce yanlış teşhis konulmaktadır. Bu raporda belirsiz ve şüpheli davranış gösteren iki hastayı ele aldık. Hastanın birine ilk olarak histeri teşhisi konmasına ragmen sonunda her ikisine birden karışık kısmi epilepsi tanısı kondu. Her ikisine anti-epileptik ilaçlar verilmesine rağmen iyileşme gözlenmedi ve belirtileri bu durum daha kötü hale gelene kadar devam etti. Son olarak pankreatik insülinom hastası oldukları ortaya çıktı. İnsülinomlar farklı ve patognomonik olmayan belirtilerinin yanı sıra nadir görülmelerinden dolayı oldukça zor teşhis edilmektedirler ve çok belirgin olmadıkça gözden kaçabilmektedirler.

Anahtar Kelimeler:

İnsülinom, pankteatik islet hücre tümörü, kompleks kısmi nöbet, davranışsal değişimler, kişilik bozuklukları.

Vague behavioral and personality changes and a misdiagnosis of complex partial epilepsy

Pancreatic insulinomas are rare endocrine tumors and their diagnosis needs a high index of suspicion. Several patients receive an initial misdiagnosis before the tumor is being finally detected. We report on two patients who presented with vague and bizarre personality and behavioral changes. One patient was initially diagnosed with hysteria and both eventually were diagnosed with complex partial epilepsy. They had not improved on anti-epileptic medications and their symptomatology continued to deteriorate. Their final diagnosis turned out to be pancreatic insulinoma. Because of the rarity of insulinomas as well as their diverse and non-pathognomonic symptoms, the diagnosis remains challenging and may quite well escape detection unless it is entertained.

Keywords:

insulinoma; pancreatic islet cell tumor; complex partial seizures; behavioral changes; personality disorders,

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Yazışma Adresi / Address for Correspondence: Dr. Osama Shukir Muhammed Amin Sulaimaniya Post-Office, PO BOX 196, Sulaimaniya City, Kurdistan Region, IRAQ E-mail: dr.osama.amin@gmail.com G eliş tarihi/Received on : 03.05.2014
Kabul tarihi/Accepted on: 30.05.2014