Expert: JM Starkman, MD - 4/14/2010

Question
Hello Dr. Starkman,
Just yesterday morning I underwent a minor procedure (transurethral botox injections) under a general anesthetic. I had some trouble afterwards with shaking/tremors, but other than that the procedure went very smoothly (this is my third time around having this). I do not have Alzheimer's, but I do have Multiple Sclerosis and of course take a whole host of medicaitons to help manage my disease. I had a consult with an anesthetist prior to my surgery and all seemed a-ok. He told me which of my scehduled meds were ok to take in the morning (hydromorph contin, Nexium, gabapentin and Wellbutrin). I took my meds at around 7am. My surgery was at 12:30 and I was home by 3pm. No problem, right?
Well, last night I went on this bizarre verbal rampage against my husband. I have never experienced anything like this before and the magnitude and intensity were surreal. I felt like I was a spectator listening to someone else scream and yell and I had no control to stop it. I said a lot of awful things that really hurt his feelings and I wouldn't normally say to a dog, let alone the centre of my little universe.I would say this went on for about 2 hours, then things settled right down and I felt like my brain 'shifted' back into normal. Of course by then the damage was done and I had one very traumatized hubby, and rightly so.
Is there any possibility I was or possibly still could be experiencing POCD? I'm trying to find a logical explanation for this horrible outburst. I already owe my husband a thousand apologies and more, but having an explanation for him would at least give us both a possible reason as to why this happened in the first place.
Thank you for generously offering your time to provide this wonderful service. I greatly appreciate it.

Lisa

Answer
POCD is marginally defined and is usually considered to be a long term complication of longer and more physiologically "insulting" surgery and anesthesia than what you had.  i.e. You had some pretty minor surgery/anesthesia not typically known to cause POCD.  The matter has been poorly studied because it's hard to study it.  My guess is that what you've experienced is not related to the botox injections or the anesthetic---but I don't know what anesthetic agents were administered.  You might want to address your question to a neuropsychiatric expert as well.