A Complicated Case of Stroke, Epilepsy, and Mood Disorder: Hyperhomocysteinemia or Medication Cascade

 Hyperhomocysteinemia is a risk factor for atherosclerosis and vascular disease, which is correlated with cerebral problems and various neurological disorders.

 We report a 20-year-old lady with a history of hyperhomocysteinemia affected with stroke, seizure, and mood disorder. By initiating medication for these illnesses, different complications appeared. During the hospital stay, drugs for treating a disease deteriorated the other. We encountered a complex patient and numerous ambiguities in her management.

 For patients with elevated serum homocysteine and psychiatry disorders, it is important to consider MTHFR gene mutation. A challenge in these patients is to select the medication that does not deteriorate hyperhomocysteinemia. In this complex case, we used carbamazepine that was accompanied by clinical improvement.