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.

Keywords: hydrocephalus; neuroimaging; psychiatry; psychotic disorders (incl schizophrenia).

Figure 1

Non-contrast enhanced CT scan. Images in transverse plane at the level of the lateral ventricles obtained before ventriculoperitoneal shunt (VPS). (A) Ventriculomegaly. (B and C) Increasing regression of ventriculomegaly 1 week (B) and 1 year (C) after placement of VPS, respectively. VPS catheter is seen in (B) and (C).

Figure 2

Non-contrast enhanced CT scan in sagittal (A) and coronal (B) plane shows ventriculomegaly of the lateral ventricles and normal calibre of the third ventricle (broad arrow). A small hyperdense colloid cyst is seen adjacent to the Foramen of Monro (thin arrow). Same findings are shown on MRI—fluid-attenuated inversion recovery (FLAIR) T1 weighted (C) and FLAIR T2 weighted (D). In (D), bilateral dilatation of the temporal horns is shown (circled on the left side). No interstitial oedema was present.