We represent the clinical case of a patient after a craniocerebral trauma, in which amnesia and attention deficit were significantly relieved after treatment with donepezil, risperidone and venlafaxine.
A 36-year-old man with a history of alcohol and drug abuse was hit by a train. Multiple fractures were found, including a fracture of the base of the skull. With computed tomography (CT), premokranium and infarction in the left caudate nucleus were determined. In the first two months of hospitalization in the intensive care unit, he had delirium. After delirium, the patient experienced dysphoria and cognitive impairment. The patient's mother died in the first days after hospitalization, but he could not realize this fact even after several repetitions.At the time of the psychiatric consultation (2 months after admission), the patient received metoclopramide, benazepril, metoprolol, hydrocodone, morphine sulfate and chloral hydrate.
The study of mental status revealed mild dysarthria, dysphoria, irritable dysphoria, concrete thinking. Thoughts about violence and psychosis were not observed. The indicator of a short scale of assessment of mental status (MMSE) is 18, with a disruption of orientation, memory, and concentration. The patient was assigned donepezil in a dosage of 5 mg per day. After 10 days, the MMSE score improved to 23. Therapy was added venlafaxine at a dosage of 75 mg / day and risperidone 0.5 mg 2 times a day. Dosages were reported: donepezil - up to 10 mg / day, venlafaxine - up to 150 mg / day, risperidone - 2 mg. After 3 more days MMSE increased to 28, dysphoria eased, the patient was able to better tell about what happened to him. He also realized that his mother had died. The man was able to complete physical rehabilitation. During follow-up, his condition remained stable with an MMSE of 29.
In this case, it is difficult to relate clinical improvement to any particular drug.But the sequence of appointments definitely speaks about the positive effect donepezil on the improvement of cognitive function. Physicians who face craniocerebral trauma should remember about anticholinesterase drugs in complex therapy.