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Case Reports in Psychiatry
Volume 2014, Article ID 953728, 3 pages
Case Report

Manic Episode after Ventricular-Peritoneal Shunt Replacement in a Patient with Radiation-Induced Hydrocephalus: The Role of Lifetime Subthreshold Bipolar Features

1Section of Psychiatry, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 57, 56100, Italy
2European Assessment Office, Italian Medicines Agency (AIFA) Via del Tritone 181, 00187 Rome, Italy

Received 30 September 2013; Accepted 15 December 2013; Published 12 January 2014

Academic Editors: F. Oyebode and L. Tamam

Copyright © 2014 Antonio Callari 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.


We present a case report of a woman hospitalized for a ventricular-peritoneal shunting replacement, who developed a manic episode with psychotic symptoms after hydrocephalus resolution. We have no knowledge of cases of manic episodes due to hydrocephalus resolution by ventricular-peritoneal shunt replacement, although previous case reports have suggested that hydrocephalus might induce rapid-onset affective episodes or mood cycles. The patient’s history revealed the lifetime presence of signs and features belonging to the subthreshold bipolar spectrum, in absence of previous full-blown episodes of a bipolar disorder. Our hypothesis is that such lifetime sub-threshold bipolar features represented precursors of the subsequent full-blown manic episode, triggered by an upregulated binding of striatum D2 receptors after the ventricular-peritoneal shunt replacement.