Signs and Symptoms of Will Graham

All pictures are not mine I took it from google. -sringmacchiato.tumblr.com

• Auditory Elemental hallucination (hearing voices/noises that are not there)

• Visual hallucination (stags and Garrett Jacob Hobbs)

• Lost of time (retrograde amnesia)• Sleep-walking • Nightmares • Hemi spatial neglect (the clock)• Delusion of persecution (Jack Crawford believes

he will kill again)

Elemental hallucination

• Hearing scratching sounds on the walls

Visual Hallucination

Lost of time

Sleep walking and nightmares

Hemispatial neglect

Actually the clock frame should be distorted too but if I’m not wrong, Hannibal drew the clock frame.

Delusion of persecution

• The beginning stage.

• Depersonalization (feels his personality is not his)

• Fregoli delusion? (hallucinating someone familiar to be replaced on someone unfamilliar)

• Tactile hallucination (hygric hallucination) -sensation of touching water

• High fever.

• Mild seizures?

Depersonalization

Fregoli?

• He thought this guy was this guy

Hygric hallucination

Seizures?

• despite popular reactions to his acting of a seizure attack, it does notdepict a typical seizure of any kind in the textbook

• There is up-rolling of eyeballs and the tonic part but the tonicity should have cause him to fall off on the floor but he was still standing…………..

• Absence seizure are transient and does not have up-rolling of eyeball or any physical signs.

Others

• Depression? Aggresion?

• In my opinion he does not display a typical depressive nor aggressive episode.

• The aggression in the episode “Roti” where he had a seizure was more of a panic attack.

• He was delirious, confused from the high fever and also from the hallucinations which are getting more vivid.

• Signs and symptoms does no coincide with schizophrenia nor bipolar disorder.

• The high fever and hemi spatial defect shows organic in pathology.

• Hemi-spatial defect shows defect to be of temporal in origin. The neglect of the left side of the hand of clock shows the lesion to be of right sided in nature pertaining the temporal lobe. The right deviation is due to the compensatory effect of the healthy left brain.

Diagnosis

• One-sided encephalitis (inflammation of the brain) is very rare. So my first thinking would have been a one-sided brain tumour.

• Anti-NMDA receptor encephalitis commonly presents to the doctors with psychotic symptoms and are also more commonly found in woman with underlying ovarian tumour.

Final Diagnosis

• Right sided anti-NMDA receptor Encephalitis