Arachnoid cyst in a patient with psychosis: Case report

We present the clinical report of a 21-year-old man, characterised by the insidious development of psychotic symptoms of varying intensity, delusional ideas with hypochondriac content, complex auditory/verbal hallucinations in the second and third persons, and aggressive behaviour. The neuroimaging studies revealed a voluminous arachnoid cyst at the level of the left sylvian fissure, with a marked mass effect on the left temporal and frontal lobes and the left lateral ventricle, as well as evidence of hypoplasia of the left temporal lobe. Despite the symptoms and the size of the cyst, the neurosurgical department opted against surgical intervention. The patient began antipsychotic therapy and was discharged having shown improvement (behavioural component), but without a complete remission of the psychotic symptoms.It is difficult to be absolutely certain whether the lesion had influence on the patient's psychiatric symptoms or not.However, given the anatomical and neuropsychological changes, one cannot exclude the possibility that the lesion played a significant role in this psychiatric presentation. This raises substantial problems when it comes to choosing a therapeutic strategy.Psychotic disorders which may be caused by either functional or organic conditions, are clinical entities characterised by changes in perception and thinking, thus interfering with the patient's social performance [1].In DSM-IV, psychosis with an organic aetiology is named "Psychotic Disorder due to a General Medical Condition" and has two subgroups: i) with hallucinations, and ii) with delusions [2]. Traumatisms or structural changes of the brain such as space-occupying lesions; biochemical changes (including intoxication with drugs); organ failure; infections; and nutritional deficiencies are all examples of causes of psychoses that are secondary to a general medical condition [1,3-6].Arachnoid cysts are benign space-occupying lesions containing CSF. They are rare lesions and account for