Behavioural Neurology

Behavioural Neurology / 2014 / Article

Case Report | Open Access

Volume 2014 |Article ID 243286 | 4 pages | https://doi.org/10.1155/2014/243286

Cavernous Angioma of the Corpus Callosum Presenting with Acute Psychosis

Academic Editor: Stefano F. Cappa
Received16 Jun 2013
Accepted12 Jul 2013
Published05 Mar 2014

Abstract

Psychiatric symptoms may occasionally be related to anatomic alterations of brain structures. Particularly, corpus callosum lesions seem to play a role in the change of patients’ behavior. We present a case of a sudden psychotic attack presumably due to a hemorrhagic cavernous angioma of the corpus callosum, which was surgically removed with complete resolution of symptoms. Although a developmental defect like agenesis or lipoma is present in the majority of these cases, a growing lesion of the corpus callosum can rarely be the primary cause. Since it is potentially possible to cure these patients, clinicians should be aware of this association.

1. Introduction

Psychiatric manifestations are rarely associated with brain tumors. For this reason, it is often difficult to assess the etiologic role of space-occupying intracranial lesions in the development of psychotic symptoms. Corpus callosum alterations are supposed to increase the risk for behavioral disturbances. However, it is not always possible to exclude the involvement of other surrounding structures. Besides developmental defects like agenesis or lipoma, the association between a well-defined callosal lesion and psychosis is very rare. We report on a patient presenting with acute psychosis associated with a hemorrhagic mid-callosal cavernous angioma.

2. Case Report

A 48-year-old Caucasian woman was compulsorily admitted to the psychiatry department of our hospital because of a sudden psychotic event, characterized by persecutory delirium with mystic content. At admission, the patient was suspicious, anxious, and only partially compliant. She had a dysphoric mood, with motor stereotypies. No previous history of mental disease was found. Family history was negative for psychiatric disorders. A pharmacological antipsychotic therapy with intramuscular promazine, lorazepam, and olanzapine was initiated, along with an individual psychotherapy. Consequently, the patient gradually recovered behavioral control and stability in her social and familial relationships. A cerebral MRI showed a cavernous angioma in the middle-third of the corpus callosum, extending upwards to the gyrus cinguli, with signs of a recent intralesional bleeding (Figure 1). The patient was scheduled for elective neurosurgical removal of the lesion. Preoperative neurological exam was normal, besides a mild impairment in recent memory. Microsurgery was performed through an interhemispheric approach. The lesion was removed enbloc from the middle-third of the corpus callosum. Pathologic examination confirmed the diagnosis of cavernous angioma. Postoperative course was uneventful. At 20-month followup the patient was fully recovered and has returned to her previous activities without any residual psychotic manifestation. Antipsychotic medications were discontinued one month after surgery.

3. Discussion

The supposed relationship between corpus callosum and behavior is well known. Many authors reported on neuropsychological disorders likely due to lesions involving the corpus callosum [1]. Moreover, the association between major psychiatric disturbance and developmental defects of the corpus callosum has been extensively discussed. Actually, most of the reported cases describe a lipoma of the corpus callosum, which is associated with agenesis in about 50% of cases [26]. Some authors hypothesized that defective interhemispheric communication, which is largely mediated by corpus callosum, may underlie schizophrenia [7]. However, the relatively small number of reported cases with schizophrenia and corpus callosum abnormalities, along with the uncertain prevalence of such anomalies in the normal population, does not allow establishing a causal relationship [2, 3]. Also tumors of the corpus callosum can be present with dementia, depression, schizophrenia, and psychosis [814]. Usually the tumors are so big that it is not easy to assess whether the primary cause of symptoms is the damage of corpus callosum or the involvement of other adjacent structures. However, in rare cases, psychiatric symptoms are associated with a well-circumscribed lesion of the corpus callosum (Table 1). We report for the first time on a mid-callosal cavernous angioma presenting with a sudden psychotic attack, in the absence of any previous psychiatric history. Apparently, the episode was related to an intralesional bleeding. Brain cavernous angiomas are rare neurovascular lesions. Seizures, focal neurological deficits, and hemorrhage are their most frequent manifestations. Particularly, hemorrhage is the most common cause of an abrupt worsening of symptoms. The patient’s gradual recovery over a few weeks is consistent with the typically benign clinical evolution after a low-pressure intracavernoma hemorrhage [15]. These clinical findings along with the MR evidence seem to exclude the presence of overlapping pathologies.


AuthorsAge, sexClinical featuresPsychiatric diagnosisOrganic diagnosisTreatmentOutcome

Durst and Rosca-Rebaudengo, 1988 [17]29, mAcute anxiety and fear of shrinkage/retraction of the penisKoro syndromeTumor of the genuElectroconvulsive shock therapy (ECT)Resolution of syndrome

Tanaghow et al., 1989 [18]DepressionTumor of anterior part

Fersten et al., 2001 [19]Disturbances of emotional-motivation processes, defects in cognitive functionsAffective and paranoid syndromesPNET of anterior part

Present case48, fAcute delirium with mystic contentAcute psychosisCavernous angioma of middle thirdGross total removalResolution of symptoms

The causal relationship between corpus callosum lesions and psychiatric symptoms is controversial. The recent literature suggests that callosal alterations more likely increase the risk for behavior disturbances, without any direct causative effect. The neurobiological mechanisms underlying the correlation between anatomical location and the psychotic disorder are unknown. Interestingly, patients after transcallosal approach are normally free of psychotic symptoms, although memory and cognitive functions might be impaired [16]. However, the rare cases of well-circumscribed lesions of the corpus callosum with psychosis point out a significant role for interhemispheric disconnection in the development of such symptoms.

4. Conclusions

Pathologies affecting the corpus callosum may cause or increase the risk for psychiatric symptoms by interfering with corticocortical interhemispheric connectivity. Both neurosurgeons and psychiatrists should be aware of occasional relationship between isolated psychotic attacks and potentially treatable intracranial lesions. The reported case underscores the importance of conducting a comprehensive neuroradiologic evaluation in patients with psychiatric disturbances.

Conflict of Interests

The authors declare that there is no conflict of interests regarding the publication of this paper.

References

  1. O. Devinsky and R. Laff, “Callosal lesions and behavior: history and modern concepts,” Epilepsy and Behavior, vol. 4, no. 6, pp. 607–617, 2003. View at: Publisher Site | Google Scholar
  2. C. R. Baumann, M. Regard, S. Trier, B. Schuknecht, and A. M. Siegel, “Lipoma on the corpus callosum in a patient with schizophrenia-like episode: is there a causal relationship?” Cognitive and Behavioral Neurology, vol. 19, no. 2, pp. 109–111, 2006. View at: Publisher Site | Google Scholar
  3. A. S. David, A. Wacharasindhu, and W. A. Lishman, “Severe psychiatric disturbance and abnormalities of the corpus callosum: review and case series,” Journal of Neurology Neurosurgery and Psychiatry, vol. 56, no. 1, pp. 85–93, 1993. View at: Google Scholar
  4. S. S. Gerber and R. Plotkin, “Lipoma of the corpus callosum. Case report,” Journal of Neurosurgery, vol. 57, no. 2, pp. 281–285, 1982. View at: Google Scholar
  5. A. Okumura, F. Hayakawa, T. Kato et al., “Callosal lesions and delirious behavior during febrile illness,” Brain and Development, vol. 31, no. 2, pp. 158–162, 2009. View at: Publisher Site | Google Scholar
  6. H. B. Pinkofsky, F. A. Struve, M. A. Meyer, G. Patrick, and R. R. Reeves, “Decreased multi-band posterior interhemispheric coherence with a lipoma on the corpus callosum: a case report of a possible association,” Clinical Electroencephalography, vol. 28, no. 3, pp. 155–159, 1997. View at: Google Scholar
  7. T. M. Chaim, M. S. Schaufelberger, L. K. Ferreira et al., “Volume reduction of the corpus callosum and its relationship with deficits in interhemispheric transfer of information in recent-onset psychosis,” Psychiatry Research, vol. 184, no. 1, pp. 1–9, 2010. View at: Publisher Site | Google Scholar
  8. C. M. Filley and B. K. Kleinschmidt-DeMasters, “Neurobehavioral presentations of brain neoplasms,” Western Journal of Medicine, vol. 163, no. 1, pp. 19–25, 1995. View at: Google Scholar
  9. M. J. G. Harrison, “Dementia due to tumours of the corpus callosum,” Postgraduate Medical Journal, vol. 60, no. 703, pp. 321–323, 1984. View at: Google Scholar
  10. S. H. Lisanby, C. Kohler, C. L. Swanson, and R. E. Gur, “Psychosis secondary to brain tumor,” Seminars in Clinical Neuropsychiatry, vol. 3, pp. 12–22, 1998. View at: Google Scholar
  11. E. A. Monaco III, H. B. Armah, M. N. Nikiforova, R. L. Hamilton, and J. A. Engh, “Grade II oligodendroglioma localized to the corpus callosum,” Brain Tumor Pathology, vol. 28, no. 4, pp. 305–309, 2011. View at: Google Scholar
  12. A. Osawa, S. Maeshima, K. Kubo, and T. Itakura, “Neuropsychological deficits associated with a tumour in the posterior corpus callosum: a report of two cases,” Brain Injury, vol. 20, no. 6, pp. 673–676, 2006. View at: Publisher Site | Google Scholar
  13. J. R. Ouma, “Psychotic manifestations in brain tumour patients: 2 case reports from South Africa,” African Health Sciences, vol. 4, no. 3, pp. 189–193, 2004. View at: Google Scholar
  14. H. Wessling, C. L. Simosono, M. Escosa-Bagé, and P. de Las Heras-Echeverría, “Anton's syndrome due to a giant anterior fossa meningioma. The problem of routine use of advanced diagnostic imaging in psychiatric care,” Acta Neurochirurgica, vol. 148, no. 6, pp. 673–675, 2006. View at: Publisher Site | Google Scholar
  15. J. Kivelev, M. Niemelä, R. Kivisaari, R. Dashti, A. Laakso, and J. Hernesniemi, “Long-term outcome of patients with multiple cerebral cavernous malformations,” Neurosurgery, vol. 65, no. 3, pp. 450–455, 2009. View at: Publisher Site | Google Scholar
  16. J. Peltier, M. Roussel, Y. Gerard et al., “Functional consequences of a section of the anterior part of the body of the corpus callosum: evidence from an interhemispheric transcallosal approach,” Journal of Neurology, vol. 259, no. 8, pp. 1860–1867, 2012. View at: Publisher Site | Google Scholar
  17. R. Durst and P. Rosca-Rebaudengo, “Koro secondary to a tumour of the corpus callosum,” British Journal of Psychiatry, vol. 153, pp. 251–254, 1988. View at: Google Scholar
  18. A. Tanaghow, J. Lewis, and G. H. Jones, “Anterior tumour of the corpus callosum with atypical depression,” British Journal of Psychiatry, vol. 155, pp. 854–856, 1989. View at: Google Scholar
  19. E. Fersten, E. Łuczywek, M. Głowacki, and Z. Czernicki, “Paranoid syndrome in a patient with tumor in anterior part of corpus callosum. Case report,” Neurologia i Neurochirurgia Polska, vol. 35, no. 4, pp. 741–747, 2001. View at: Google Scholar

Copyright © 2014 Giacomo Pavesi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2421 Views | 508 Downloads | 1 Citation
 PDF  Download Citation  Citation
 Download other formatsMore
 Order printed copiesOrder

We are committed to sharing findings related to COVID-19 as quickly and safely as possible. Any author submitting a COVID-19 paper should notify us at help@hindawi.com to ensure their research is fast-tracked and made available on a preprint server as soon as possible. We will be providing unlimited waivers of publication charges for accepted articles related to COVID-19. Sign up here as a reviewer to help fast-track new submissions.