Arachnoid cyst in a patient with psychosis: Case report

Abstract

BackgroundThe aetiology of a psychotic disturbance can be due to a functional or organic condition. Organic aetiologies are diverse and encompass organ failures, infections, nutritional deficiencies and space-occupying lesions. Arachnoid cysts are rare, benign space-occupying lesions formed by an arachnoid membrane containing cerebrospinal fluid (CSF). In most cases they are diagnosed by accident. Until recently, the coexistence of arachnoid cysts with psychiatric disturbances had not been closely covered in the literature. However, the appearance of some references that focus on a possible link between arachnoid cysts and psychotic symptoms has increased the interest in this subject and raised questions about the etiopathogeny and the therapeutic approach involved.Clinical presentationWe present the clinical report of a 21-year-old man, characterised by the insidious development of psychotic symptoms of varying intensity, delusional ideas with hypochondriac content, complex auditory/verbal hallucinations in the second and third persons, and aggressive behaviour. The neuroimaging studies revealed a voluminous arachnoid cyst at the level of the left sylvian fissure, with a marked mass effect on the left temporal and frontal lobes and the left lateral ventricle, as well as evidence of hypoplasia of the left temporal lobe. Despite the symptoms and the size of the cyst, the neurosurgical department opted against surgical intervention. The patient began antipsychotic therapy and was discharged having shown improvement (behavioural component), but without a complete remission of the psychotic symptoms.ConclusionIt is difficult to be absolutely certain whether the lesion had influence on the patient's psychiatric symptoms or not.However, given the anatomical and neuropsychological changes, one cannot exclude the possibility that the lesion played a significant role in this psychiatric presentation. This raises substantial problems when it comes to choosing a therapeutic strategy.

A Case of Clozapine-Resistant Schizophrenia Associated With a Large Arachnoid Cyst in the Left Sylvian Fissure

“…We hypothesized that the patient's psychopathological symptoms did not respond to clozapine medication due to the relatively large size of the cerebral lesion. Our speculation is consistent with the assumptions proposed by previous case reports [1][2][3][4][5][6][7][8][9][10]. Recently, Baquero and colleagues presented the case of an arachnoid cyst-related psychotic disorder is remitted in terms of the psychotic symptoms [19].…”

“…This suggests that reduced cerebral lateralization may have given rise to the symptomatology in our patient [3][4][5][6]. This case further suggested that reduced brain lateralization might also contribute to the refractoriness of schizophrenia to clozapine and other antipsychotic medications.…”

“…There are rare cases of comorbidity of arachnoid cysts with psychiatric disease, which manifest as cognitive impairment, delusional ideation, hallucinations, pseudologia fantastica, and catatonia. Although the nature of the relationship between arachnoid cysts and psychosis is not well understood, the location of the lesion influences the specific pattern of the illness [3][4][5][6][7][8][9][10].…”

REM Sleep Behavior Disorder Accompanying Arachnoid Cyst: A Case Report

“…Arachnoid cysts can cause many different neuropsychiatric symptoms depending on their location. All of these effects and symptoms are caused either by compression of the cyst on the surrounding brain tissue or interference with the functions of the surrounding neurologic structures (da Silva et al 2007;Wester, 2008).…”

Bilateral Subdural Hygroma in a Case with Sylvian Arachnoid Cyst

“…Arachnoid cysts most commonly present during childhood and are usually identified incidentally. About 75% of intracranial arachnoid cysts presented before 3 years of age in one series [5]. The most common symptoms include headache and seizures.…”