Here the central problem must be clarified by determining whether the patient is delirious (clouding of consciousness, psychomotor overactivity, and hallucinations), deluded (schizophrenia), manic (overactive, flight of ideas), or experiencing an isolated panic attack (palpitation, trembling, feeling of suffocation). Rarely does panic prove to be an expression of temporal lobe epilepsy. In an adult without a characterologic trait of anxiety, an acute panic attack may signify the onset of a depressive illness or schizophrenia.
Although these symptoms are usually caused by a psychosis (schizophrenia or bipolar disease), one should consider a tumor, immune or paraneoplastic encephalitis, or other lesion of the temporal lobe, particularly when accompanied by temporal lobe seizures, aphasic symptoms, rotatory vertigo (rare), and quadrantic visual field defects. Such states have also been described in hypothalamic disease, suggested by somnolence, diabetes insipidus, visual field defects, and in hydrocephalus (see Chap. 27).
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