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Qureshi HM, Mekbib KY, Allington G, Elsamadicy AA, Duy PQ, Kundishora AJ, Jin SC, Kahle KT. Familial and syndromic forms of arachnoid cyst implicate genetic factors in disease pathogenesis. Cereb Cortex 2023; 33:3012-3025. [PMID: 35851401 PMCID: PMC10388392 DOI: 10.1093/cercor/bhac257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/01/2022] [Accepted: 06/04/2022] [Indexed: 11/13/2022] Open
Abstract
Arachnoid cysts (ACs) are the most common space-occupying lesions in the human brain and present significant challenges for clinical management. While most cases of ACs are sporadic, nearly 40 familial forms have been reported. Moreover, ACs are seen with increased frequency in multiple Mendelian syndromes, including Chudley-McCullough syndrome, acrocallosal syndrome, and autosomal recessive primary ciliary dyskinesia. These findings suggest that genetic factors contribute to AC pathogenesis. However, traditional linkage and segregation approaches have been limited in their ability to identify causative genes for ACs because the disease is genetically heterogeneous and often presents asymptomatically and sporadically. Here, we comprehensively review theories of AC pathogenesis, the genetic evidence for AC formation, and discuss a different approach to AC genomics that could help elucidate this perplexing lesion and shed light on the associated neurodevelopmental phenotypes seen in a significant subset of these patients.
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Affiliation(s)
- Hanya M Qureshi
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Kedous Y Mekbib
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
| | - Garrett Allington
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Phan Q Duy
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Adam J Kundishora
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
| | - Sheng Chih Jin
- Department of Genetics, Washington University School of Medicine, St. Louis, MO 63110, United States
| | - Kristopher T Kahle
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT 06510, United States
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, United States
- Division of Genetics and Genomics, Boston Children’s Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
- Department of Neurology, Harvard Medical School, Boston, MA 02115, United States
- Broad Institute of MIT and Harvard, Cambridge, MA 02142, United States
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Lu Y, Tian Y, Gan Y, Fu Y, Chen Q, Zou L, Zhao B, Yan Y, Liu S, Chen X, Li X. The Efficacy and Tolerability of Electroconvulsive Therapy in Psychiatric Patients with Arachnoid Cysts: A Retrospective Chart Study. Brain Sci 2022; 12:brainsci12101393. [PMID: 36291326 PMCID: PMC9599128 DOI: 10.3390/brainsci12101393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 11/16/2022] Open
Abstract
Electroconvulsive therapy (ECT) is an effective therapy for many psychiatric illnesses. However, intracranial occupying lesions are a relative contraindication to ECT. Arachnoid cysts are benign, congenital, and space-occupying lesions. Our study aimed to evaluate the efficacy and tolerability of ECT in psychiatric patients with arachnoid cysts. We retrospectively identified 62 psychiatric patients with arachnoid cysts; 43 of them underwent ECT and 19 did not. Their conditions were assessed by CGI-S and different scales depending on different diagnoses (PANSS for schizophrenia; HAMD for depression; YMRS for bipolar disorder). The side effect was assessed by TESS. Significant differences were shown in the reduced scores of the CGI-S between patients who underwent ECT and those who did not (p = 0.001), while, at the same time, there was no significant difference in their TESS score (p = 0.297). The current study found that ECT is an effective and tolerable therapy for psychiatric patients with arachnoid cysts.
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Affiliation(s)
- Ying Lu
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Tian
- Department of the First Clinical Medicine, Chongqing Medical University, Chongqing 400016, China
| | - Yu Gan
- Department of Psychiatry, Chongqing Eleventh People’s, Chongqing 400038, China
| | - Yixiao Fu
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Qibin Chen
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Lei Zou
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Bangshu Zhao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yu Yan
- Information Center, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shudong Liu
- Department of Clinical Psychology II, Chongqing Mental Health Center, Chongqing 400030, China
| | - Xiaolu Chen
- The First Branch, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400015, China
- Correspondence: (X.C.); (X.L.)
| | - Xiao Li
- Department of Psychiatry, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
- Correspondence: (X.C.); (X.L.)
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Biswas R, Sen I. Seizures and Postictal Psychosis in a Patient With Retrocerebellar Arachnoid Cyst: A Case Report. Cureus 2022; 14:e24935. [PMID: 35698697 PMCID: PMC9187137 DOI: 10.7759/cureus.24935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 11/06/2022] Open
Abstract
Retrocerebellar arachnoid cysts are uncommon intracranial tumors, especially rare in adults. Although asymptomatic in the majority of cases, they may cause a variety of symptoms including convulsions. The causal involvement of these cysts in postictal psychosis, however, remains a topic that is not well-explained in the literature. An 85-year-old Asian man presented with recurrent episodes of convulsions for the last seven months along with preceding headaches and postictal psychotic symptoms. MRI of the head revealed a retrocerebellar arachnoid cyst. He was commenced on symptomatic pharmacological therapy after he refused surgical intervention and remained symptom-free till his discharge from the hospital before being eventually lost to follow-up. This case report focuses on the rare occurrence of a retrocerebellar arachnoid cyst with seizures and postictal psychosis and illustrates the necessity of further case studies and research to identify and explore the potential causal relationship between arachnoid cysts and psychosis.
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Kantipudi S, Suresh N. Intracranial arachnoid cysts presenting with first-episode mania and subsequent hyperammonemic encephalopathy: A case report. ANNALS OF INDIAN PSYCHIATRY 2022. [DOI: 10.4103/aip.aip_101_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Varshney P, Raghuraman BS, Ganjekar S, Sharma M, Chaturvedi S. Cerebellar arachnoid cyst masquerading initially as schizophrenia and later as obsessive compulsive disorder. Asian J Psychiatr 2020; 47:101838. [PMID: 31706227 DOI: 10.1016/j.ajp.2019.10.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 10/13/2019] [Accepted: 10/13/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Prateek Varshney
- National Institute of Mental Health and Neuro Sciences, 560029, Bangalore, India
| | | | - Sundarnag Ganjekar
- National Institute of Mental Health and Neuro Sciences, 560029, Bangalore, India.
| | - Manoj Sharma
- National Institute of Mental Health and Neuro Sciences, 560029, Bangalore, India
| | - Santosh Chaturvedi
- National Institute of Mental Health and Neuro Sciences, 560029, Bangalore, India
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Cohen MA, Cohen NA, Moonis G, Kennedy DW. Long-term Follow-up of a Multiloculated Arachnoid Cyst of the Middle Cranial Fossa. EAR, NOSE & THROAT JOURNAL 2019. [DOI: 10.1177/014556130708600611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Arachnoid cysts are benign intracranial lesions that are typically diagnosed incidentally. We describe the case of a 56-year-old man who presented with a multiloculated arachnoid cyst of the middle cranial fossa that extended into the sphenoid sinus. The lesion was identified on computed tomography of the head, which had been obtained for an unrelated investigation. However, establishing a definitive diagnosis proved to be difficult. Because the cyst had caused extensive skull base erosion, the patient was managed conservatively with close observation. We report the radiographic progression of this lesion during more than a decade of follow-up, and we review the literature pertaining to the presentation, pathophysiology, and treatment of arachnoid cysts.
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Affiliation(s)
- Marc A. Cohen
- Department of Otorhinolaryngology–Head and Neck Surgery,University of Pennsylvania School of Medicine, Philadelphia
| | - Noam A. Cohen
- Department of Otorhinolaryngology–Head and Neck Surgery,University of Pennsylvania School of Medicine, Philadelphia
| | - Gul Moonis
- Department of Radiology, University of Pennsylvania School of Medicine, Philadelphia
| | - David W. Kennedy
- Department of Otorhinolaryngology–Head and Neck Surgery,University of Pennsylvania School of Medicine, Philadelphia
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Gjerde PB, Litleskare S, Lura NG, Tangen T, Helland CA, Wester K. Anxiety and Depression in Patients with Intracranial Arachnoid Cysts-A Prospective Study. World Neurosurg 2019; 132:e645-e653. [PMID: 31442638 DOI: 10.1016/j.wneu.2019.08.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Arachnoid cysts yield cognitive deficits that are normalized after surgical cyst decompression. OBJECTIVE The present study aimed to investigate whether arachnoid cysts also affect symptoms of anxiety and depression, and if surgical cyst decompression leads to reduction of these symptoms. METHODS Twenty-two adult patients (13 men and 9 women) with symptomatic temporal or frontal cysts were included in this questionnaire (Hospital Anxiety and Depression Scale [HADS])-based prospective study. The mean time between answering the preoperative questionnaire and surgery was 37 days. The patients answered the same HADS questionnaire 3-6 months postoperatively. RESULTS Preoperatively, both patients with frontal (N = 4) and patients with temporal (N = 18) cyst had higher mean HADS anxiety scores than those found in the general population. For patients with temporal cyst, there was a significant or near-significant difference in anxiety and depression scores and the combined scores between those with right-sided cysts and those with left-sided cysts. Postoperatively, the HADS scores normalized and were no longer different from those of the general population. The difference in scores between patients with right and left temporal cyst also disappeared. CONCLUSIONS Patients with arachnoid cyst have higher levels of anxiety and depression than do the general population and these scores were normalized after decompressive cyst surgery. We further found a hemispheric asymmetry: patients with a right temporal cyst showed higher anxiety, depression, and combined scores than did patients with a left temporal cyst. Also, this disparity normalized after cyst decompression. Thus, arachnoid cysts seem to affect not only cognition but also the level of affective symptoms.
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Affiliation(s)
- Priyanthi B Gjerde
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; The Norwegian Centre for Mental Disorders Research (NORMENT) and the K.G. Jebsen Centre for Psychosis Research, Department of Clinical Medicine K2, University of Bergen, Bergen, Norway
| | - Sverre Litleskare
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Research Unit for General Practice, Uni Research Health, Bergen, Norway
| | - Njål Gjærde Lura
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department of Radiology, Haukeland University Hospital, Bergen, Norway
| | - Tone Tangen
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Section of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christian A Helland
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department Neurosurgery, Haukeland University Hospital, Bergen, Norway
| | - Knut Wester
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway; Department Neurosurgery, Haukeland University Hospital, Bergen, Norway.
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Ranjan R, Nath S, Mohapatra D, Mishra BR. "I am a sinner": Rathke's cleft cyst masquerading as delusion of guilt. Asian J Psychiatr 2018; 32:159-160. [PMID: 29289857 DOI: 10.1016/j.ajp.2017.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 11/19/2022]
Affiliation(s)
- Rajeev Ranjan
- Department of Psychiatry, Room No. 411, Academic Block, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Santanu Nath
- Department of Psychiatry, Room No. 411, Academic Block, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Debadatta Mohapatra
- Department of Psychiatry, Room No. 411, Academic Block, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
| | - Biswa Ranjan Mishra
- Department of Psychiatry, Room No. 411, Academic Block, All India Institute of Medical Sciences, Bhubaneswar, 751019, India.
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Pientka LJ, Schulz SC, Lim KO, Jasberg SG. The Clinical Impact of Neuroimaging in First-Episode Psychosis. CLINICAL SCHIZOPHRENIA & RELATED PSYCHOSES 2017:CSRP.LPSS.111717. [PMID: 29164931 DOI: 10.3371/csrp.lpss.111717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Laura J Pientka
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - S Charles Schulz
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Kelvin O Lim
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
| | - Suzanne G Jasberg
- Department of Psychiatry, University of Minnesota, Minneapolis, MN, USA
- PrairieCare, A University of Minnesota Medical School Affiliate, Minneapolis, MN, USA
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Tonna M, Ottoni R, Ossola P, De Panfilis C, Marchesi C. Late-onset obsessive-compulsive disorder associated with left cerebellar lesion. THE CEREBELLUM 2015; 13:531-5. [PMID: 24771488 DOI: 10.1007/s12311-014-0561-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The onset of obsessive-compulsive disorder (OCD) after age 50 is rare and generally related to an organic etiology. An involvement of fronto-striatal circuits has been strongly suggested, whereas cerebellum remains so far scarcely explored. We present here the description of a "pure" late-onset OCD associated with a cerebellar lesion, neither comorbid with other mental disorders nor with neurological syndromes. To our knowledge, this condition was not previously described in literature. The patient is a 62-year-old woman who developed a late-onset OCD associated with a left cerebellar lesion due to an arachnoid cyst in the left posterior fossa. We debate the possible role of the cerebellar lesion in favoring a transition from a predisposing liability (namely an obsessive-compulsive personality disorder and a depressive status) to the onset of OCD in this woman.
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Affiliation(s)
- Matteo Tonna
- Mental Health Department, Local Health Service, Parma, Italy
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Acute onset of psychosis in a patient with a left temporal lobe arachnoid cyst. Case Rep Med 2014; 2014:204025. [PMID: 24715905 PMCID: PMC3970447 DOI: 10.1155/2014/204025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/03/2014] [Indexed: 11/17/2022] Open
Abstract
Arachnoid cysts are considered a rare neurological tumor, few of which exhibit any symptomatology. A 38-year-old Haitian American female with no past psychiatric history presented with rapid onset of psychosis. Workup for medical etiology proved to be within normal limits, with the exception of a left temporal lobe arachnoid cyst. The purpose of this paper is to add to a number of existing case reports that suggest a relationship between such lesions and psychiatric illness.
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Baquero GA, Molero P, Pla J, Ortuño F. A schizophrenia-like psychotic disorder secondary to an arachnoid cyst remitted with neurosurgical treatment of the cyst. Open Neuroimag J 2014; 8:1-4. [PMID: 24653786 PMCID: PMC3959176 DOI: 10.2174/1874440001408010001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Revised: 01/31/2014] [Accepted: 02/22/2014] [Indexed: 12/02/2022] Open
Abstract
We describe a case of delusional psychosis that was terminated by neurosurgical removal of a large arachnoid
cyst. The patient was suffering his first psychotic episode and had symptoms typical of schizophrenia. The case underscores the importance of considering that an arachnoid cyst can induce psychopathological symptoms,
even those of schizophrenia. Indeed, such symptoms may be the cyst's only clinical manifestation. In addition, the case highlights the importance of doing a structural imaging test when confronted with a first episode of
psychosis, especially if the episode is relatively late in appearance. Such imaging may lead to a diagnosis that in turn can
enable a definitive neurosurgical resolution of the psychosis.
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Affiliation(s)
- G A Baquero
- Department of Psychiatry and Medical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - P Molero
- Department of Psychiatry and Medical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - J Pla
- Department of Psychiatry and Medical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
| | - F Ortuño
- Department of Psychiatry and Medical Psychology, Clínica Universidad de Navarra, Pamplona, Spain
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Park YS, Eom S, Shim KW, Kim DS. Neurocognitive and psychological profiles in pediatric arachnoid cyst. Childs Nerv Syst 2009; 25:1071-6. [PMID: 19357855 DOI: 10.1007/s00381-009-0872-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This study aims to investigate whether intracranial arachnoid cysts (AC) compromise neurocognitive function and psychological profiles in pediatric patients, depending on various clinical factors. METHODS We assessed neurocognitive functions and psychological tests in 35 AC patients and 35 healthy control subjects between October 2007 and April 2008. AC patients ranged in age from 3 to 15 (7.94 +/- 3.12) years old and control patients from 5 to 13 (8.84 +/- 2.17) years old. The location of the AC were temporal (n = 22), frontal (n = 6), suprasellar (n = 4), and posterior fossa (n = 3). Patients underwent neurocognitive and psychological assessments before surgery. To investigate which AC impair neurocognitive function and psychological profile, we assessed intelligence, memory, attention, executive function, behavioral problems, emotional distress, and parenting stress. RESULTS AC caused some demonstrated impairment by both neurocognitive function and psychological assessments. Left hemisphere AC tended to have more anxiety; mood changes can be detected depending on cyst grade. An incidental finding of AC after trauma is more intelligent, well-reserved executive function. Frontal locations tended to cause more anxiety than temporal locations. CONCLUSIONS Our results imply that intracranial AC impairs some neurocognitive and psychological functions. An incidental finding of AC after trauma was a more intelligent, well-reserved executive function. AC in the left hemisphere, frontal location tended to cause more anxiety. The AC itself did not cause differences in neurocognitive function from the control group. However, parenting stress in the AC group was much higher than in the control group.
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Affiliation(s)
- Young Seok Park
- Department of Pediatric Neurosurgery, Severance Children's Hospital, Brain Research Institute, Yonsei University College of Medicine, 134, Shinchon-dong, Seodaemoon-gu, Seoul 120-752, Republic of Korea
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Vakis AF, Koutentakis DI, Karabetsos DA, Kalostos GN. Psychosis-like syndrome associated with intermittent intracranial hypertension caused by a large arachnoid cyst of the left temporal lobe. Br J Neurosurg 2009; 20:156-9. [PMID: 16801049 DOI: 10.1080/02688690600776986] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Lesions on certain brain areas can cause psychiatric signs. Symptomatic arachnoid cysts can produce a variety of symptoms like headache, seizures, increased ICP, and rarely psychiatric disorders. We report a case of a young woman with a left temporal lobe arachnoid cyst, presented with headache and an atypical psychosis. A 72-h epidural ICP recording revealed incidental elevation of ICP. After a permanent shunt was placed, patient's symptoms improved substantially, and antipsychotic medication was significantly reduced.
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Affiliation(s)
- Antonis F Vakis
- Department of Neurosurgery, University of Crete, Medical School, Heraklion University Hospital, Heraklion, Crete, Greece
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Kalapatapu RK. Aripiprazole treatment of psychosis in a child with posterior fossa retrocerebellar arachnoid cyst. J Child Adolesc Psychopharmacol 2009; 19:321-5. [PMID: 19519272 DOI: 10.1089/cap.2008.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Raj K. Kalapatapu
- Department of Geriatric Psychiatry, Mount Sinai School of Medicine, New York, New York
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Intracranial arachnoid cysts – do they impair mental functions? J Neurol 2008; 255:1113-20. [DOI: 10.1007/s00415-008-0011-y] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2008] [Revised: 05/09/2008] [Accepted: 05/19/2008] [Indexed: 11/24/2022]
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17
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Kuloglu M, Caykoylu A, Yilmaz E, Ekinci O. A left temporal lobe arachnoid cyst in a patient with schizophrenia-like psychosis: a case report. Prog Neuropsychopharmacol Biol Psychiatry 2008; 32:1353-4. [PMID: 18514993 DOI: 10.1016/j.pnpbp.2008.04.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 04/18/2008] [Accepted: 04/22/2008] [Indexed: 10/22/2022]
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da Silva JA, Alves A, Talina M, Carreiro S, Guimarães J, Xavier M. Arachnoid cyst in a patient with psychosis: Case report. Ann Gen Psychiatry 2007; 6:16. [PMID: 17598903 PMCID: PMC1933420 DOI: 10.1186/1744-859x-6-16] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2007] [Accepted: 06/28/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 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 PRESENTATION We 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. CONCLUSION It 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.
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Affiliation(s)
- Joaquim Alves da Silva
- Depart. Psychiatry and Mental Health, Faculty Medical Sciences – UNL Calçada da Tapada, 155, 1300-Lisbon, Portugal
| | - Alexandra Alves
- Depart. Psychiatry – Hospital S. Francisco Xavier, 1400-Lisbon, Portugal
| | - Miguel Talina
- Depart. Psychiatry and Mental Health, Faculty Medical Sciences – UNL Calçada da Tapada, 155, 1300-Lisbon, Portugal
| | - Susana Carreiro
- Depart. Psychiatry – Hospital S. Francisco Xavier, 1400-Lisbon, Portugal
| | - João Guimarães
- Depart. Neurology, Faculty Medical Sciences – Hospital Egas Moniz, 1400-Lisbon, Portugal
| | - Miguel Xavier
- Depart. Psychiatry and Mental Health, Faculty Medical Sciences – UNL Calçada da Tapada, 155, 1300-Lisbon, Portugal
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