Psychosis in a Case of Dandy-Walker Syndrome: A Case Report

Abstract

An 18-year-old, single, unemployed male was brought by his mother with chief complaints of repeated falls and headache since the past one month, decreased self care since six days, angryabusive behaviour since two days. The patient was a known case of seizure disorder and intellectual impairment. His last seizure episode was a month prior to presentation. The patient was born preterm at seven months and was kept in an incubator and given multiple blood transfusions 4-5 days after birth (details of which were unknown). The patient was apparently alright till the age of three years when he started having episodes of loss of consciousness associated with frothing from mouth for which he was taken to a hospital and diagnosed as a case of seizure disorder and started on treatment (sodium phenytoin). The patient dropped out of school at 5 th standard as he continued to have episodes of seizures and academic difficulties. The patient had difficulty in calculation and needed assistance in activities of daily living. The patient used to do odd jobs like working as helper in shop or sometimes as daily wage laborer to earn for himself.A month prior to presentation, he started having sudden onset episodes of generalized headache which were severe, continuous and sometimes associated with non-projectile vomiting. Headache did not respond to medications given by the family physician and the patient was brought to our hospital and suspected to have a Viral encephalopathy and started on by the medical team on intravenous mannitol, dexamethasone, phenytoin, ceftriaxone, vancomycin and acyclovir. Magnetic Resonance Imaging (MRI) study of the brain revealed inferior cerebellar vermian hypoplasia with fourth ventricle seen communicating with cisterna magna through a keyhole defect suggestive of Dandy Walker variant [Table/ Fig-1,2].The patient improved symptomatically on the above treatment and was discharged after two weeks with advice to continue oral medication like sodium phenytoin 100 mg thrice a day, ondansetron 4 mg twice a day, pantoprazole 40 mg once a day, calcium supplements and Carbamezapine 200 mg thrice a day.The patient was maintained on same and after about a month, without any apparent reasons, he started showing altered behaviour in form of angry-abusive behaviour towards his mother and others.He showed decreased self care and stopped bathing. He had difficulty in eating food by self and would not allow his mother to AbSTRACTDandy Walker Syndrome (DWS) is a congenital malformation with brain abnormalities, intellectual disabilities, epilepsy and visible structural changes in particular brain structures. We present here a case of psychosis in an 18-year-old male with DWS, epilepsy and intellectual disability. The purpose of this paper is to discuss the clinically relevant issues, psychopharmacological issues, neuropsychiatric manifestations and consultation liaison issues involved.

Dandy–Walker malformation and intermittent explosive disorder: A case report

“…Mental retardation is also reasonably associated with DWM, 19 along with bipolar disorder. 5 In our patient, we did not find features suggestive of schizophrenia, depression, or bipolar disorder.…”

Dandy-Walker Malformation-Like Condition Revealed by Refractory Schizophrenia: A Case Report and Literature Review

“…We reviewed all reported cases of posterior fossa abnormalities associated with schizophrenia or psychosis using a PubMed search query and identified 24 cases in the 18 studies published in the English language between 1996 and 2017. The literature is limited to single case reports or case series of schizophrenia [32-41] or psychosis [23, 42-49] (Table 1). Most cases of schizophrenia were associated with DWV and only one was associated with DWM or MCM.…”

Dandy-Walker variant associated with bilateral congenital cataract

“…D-WS is more common in females than males. [ 9 ] D-WV is described by cystic dilatation of the fourth ventricle and hypoplasia of the inferior vermis in the absence of posterior fossa enlargement. [ 10 ] Dandy-Walker malformations and related variants affect an estimated one in every 35,000 live births.…”