A case of psychotic disorder associated with a right temporal lesion: A special reference to magnetic resonance imaging and single photon emission computed tomography findings

Abstract

A number of studies demonstrated a close association between psychotic symptoms and temporal lobe abnormalities. For example, it is well known that psychosis occurs in association with temporal lobe epilepsy, [1][2][3] and recent studies demonstrate morphological and functional abnormalities in the temporal lobe of schizophrenic brains. [4][5][6][7] In addition, there are some reports demonstrating focal temporal lesions such as stroke, 8 trauma 8 as well as brain tumors 9,10 as a causal lesion for psychotic disorder. To our knowledge, however, very few studies of organic psychotic disorder using magnetic resonance imaging (MRI) and single photon emission computed tomography (SPECT). In this paper we described a patient with psychotic disorder associated with a right temporal lesion with reference to MRI and SPECT findings. CASE REPORTAn 18-year-old, right-handed male was referred to a neurosurgeon because of right-sided facial sensory loss for 5 years. Physical examination on admission revealed abducent palsy, trigeminal palsy and cerebella ataxia on the right side. He had no mental problem except occasional sexual disinhibitory behaviors. There was no family history of any neuropsychiatric disorders. The brain MRI before brain surgery (Fig. 1a,b,c,d) revealed a tumor occupying from the cerebellopontine angle to the right middle cranial fossa and compressing the brainstem and right temporal lobe. The tumor, pathologically diagnosed as trigeminal Schwannoma was almost completely removed Psychiatry and Clinical Neurosciences (1999) AbstractA case of psychotic disorder with a right temporal lesion was reported. The patient, a 19 year old male, who underwent a brain surgery to remove the trigeminal Schwannoma, occupying from the right cerebellopontine angle to the right middle cranial fossa. One year postoperatively, he presented with a psychotic disorder, including auditory hallucinations, delusions of persecution and reference, thought hearing, thought insertion and passive experiences. T1-weighted images on magnetic resonance imaging (MRI) demonstrated a low intensity signal area in the right temporal cortex and white matter. T2-weighted images demonstrated a high intensity signal within the same region. Single photon emission computed tomograghy (SPECT) demonstrated a severe low perfusion corresponding to the region in which the MRI demonstrated the abnormalities. The clinical and neuroimaging studies of this case suggest that psychotic disorder may occur in association with a right temporal lesion and MRI and SPECT are useful to evaluate an organic basis for the psychotic disorder.

Belief and awareness: reflections on a case of persistent anosognosia

“…These included delusions based on autobiographical memory failures, place misidentification with double orientation and persecutory delusional beliefs about staff members and their intentions. Similar neuropsychiatric symptoms have been argued, on the basis of case and cohort studies in AD, to arise from regional neuropsychological failures in a context of disturbances in reality monitoring due to right hemisphere dysfunction (Feinberg & Shapiro, 1989;Förstl, Almeida, Owen, Burns, & Howard, 1991;Mizukami, Yamakawa, Yokoyama, Shiraishi, & Kobayashi, 1999;Shanks & Venneri, 2002;Staff et al, 1999). Such symptoms are seen with highest frequency in patients with right frontoparietal dysfunction.…”

A Vanishing Lesion in the Temporal Lobe Associated With Schizophrenialike Psychosis and Catatonia

“…12,13 Also in nonepileptic patients several cases of temporal lobe lesions associated with psychotic symptoms have been described. For example, Ortiz et al 14 described a patient developing psychotic depression having acquired an ischemic left temporal lesion, whereas Mizukami et al 15 reported on a psychotic patient with a right temporal lesion of unknown origin. Blackshaw and Bowen 16 presented a patient with atypical psychosis cooccurring with a left fronto-temporal arachnoidal cyst.…”

A Case of Right Cerebellopontine-Angle Lesion: Psychotic Symptoms and Magnetic Resonance Imaging Findings

“…One report described how a focal temporal-lobe tumor expanded to the CPA and caused postoperativepsychotic symptoms 5. However, in cases where psychotic patients show few or no neurological symptoms, magnetic resonance imaging (MRI) can be an extremely useful tool for evaluating organic lesions; this is often overlooked by psychiatrists.…”