Obstructive hydrocephalus caused by colloid cyst presenting as a schizophrenia-like psychosis

Abstract

This report presents a young woman with psychotic symptoms that were highly suspicious of schizophrenia. Previous attempts of antidepressant therapy of mood symptoms had been ineffective. However, she also presented with discrete signs of an underlying neurological condition, and as a part of the diagnostic workup, neuroimaging revealed ventriculomegaly. She was diagnosed with obstructive hydrocephalus and experienced full remission of psychotic symptoms after neurosurgical intervention with a ventriculoperitoneal shunt. This atypical presentation of obstructive hydrocephalus underlines the importance of neuroimaging in psychiatric differential diagnostics. Otherwise, this young woman had been diagnosed with schizophrenia, instead of organic delusional disorder secondary to a neurological condition, with possible irreversible damage to brain tissue as a consequence.

Colloid Cyst Presenting With Severe Headache and Bilateral Leg Weakness: Case Report and Review

“…Obstructive hydrocephalus of the third ventricle can cause alterations in mental status and memory, loss of bladder control and weakness, and ataxia of the lower extremities [ 1 ]. Lower extremity weakness appears to be a result of pressure on the lateral wall of the third ventricle, with a subsequent pressure effect on the pyramidal fibers to the legs, which are adjacent to the wall of the third ventricle [ 6 ].…”

“…These symptoms can include urinary incontinence, alterations in mental status, memory problems, weakness, and ataxia of the lower extremities, as was seen in the case presented [ 4 ]. Alterations in mental status can present as a schizophrenia-like psychosis [ 6 - 7 ]. New-onset seizure activity has been described as a presentation of colloid cysts of the third ventricle [ 8 ].In children, the most common symptoms are headaches associated with nausea and vomiting [ 9 ].…”

PCM1 is necessary for focal ciliary integrity and is a candidate for severe schizophrenia

“…Indeed, defective cilia during development frequently lead to severe hydrocephalus and multi-organ dysfunction incompatible with life [49][50][51][52][53] . As severe congenital hydrocephalus is an extremely dangerous condition, affected individuals may not be healthy enough to undergo proper psychiatric evaluations; however, apparent adult hydrocephalus has been reported to be comorbid with psychosis and paranoid delusions [54][55][56] . Others have proposed a CSF-forward model of SZ, but causality has not been tested explicitly 57 .…”

Brain anomalies in early psychosis: From secondary to primary psychosis

“…We found several cases of ventricular enlargement due to acquired hydrocephalus and associated with psychosis. While psychotic symptoms were accompanied by other neurologic signs such as gait and coordination deficits in a case of obstructive hydrocephalus caused by a colloid cyst (Højlund et al 2018), red flags suggesting a secondary psychosis might sometimes be less obvious. Thus, subtle bradykinesia and mild non-localizing cognitive impairment may have been overshadowed by the initial psychotic presentation with aggressive behavior and delusions of persecution, in a case of normal pressure hydrocephalus due to idiopathic aqueductal stenosis (Chatziioannidis et al 2013).…”