Psychosis Associated with Acquired Porencephaly-Cause or Incidental Finding? Case Report and Review of Literature

Abstract

Porencephaly, a rare disease affecting the central nervous system, is represented by a cerebrospinal fluid-filled cavity in the brain. There are two types of porencephalic cavities: congenital and acquired. Porencephaly is mainly associated with neurological and developmental consequences. Associated psychotic symptoms were reported in a few cases, and due to this fact, there is a knowledge gap regarding the diagnostic and therapeutic approach to such cases. We present the case of a 32-year-old male diagnosed with a psychotic disorder associated with acquired porencephaly. The porencephalic cystic lesions were most probably due to a traumatic brain injury at the age of 6 years old. The psychotic symptomatology consisted of interoceptive/visceral hallucinations, delusions with persecutory and religious/magic content and disorganised behaviour. The porencephalic cavity was confirmed by a computed tomography scan. The patient was treated over the course of time with risperidone, olanzapine and zuclopenthixol. The existing literature regarding other cases of psychosis associated with porencephaly is discussed. In conclusion, even though porencephaly was asymptomatic for a long period of time, we argue that there is a causal relationship between the chronic psychotic symptoms and the porencephalic cyst in our case.

Keywords: cyst; encephalomalacia; frontal lobe; organic brain disorder; organic personality; porencephaly; psychosis.

Figure 1

Computed tomography 3D bone reconstruction (A,B) and axial computed tomography of the brain (C–F). A post-traumatic bone defect of the skull can be seen in (A–F) shows changes of encephalomalacia in the frontal lobes’ parenchyma, affecting both white and grey matter, more extended on the left side, with enlargement of the anterior ventricular horn (aspect of acquired porencephalic lesions).