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Refractory psychosis and prominent cognitive deficits in a patient with mega-cisterna magna.

Ferentinos PP, Kontaxakis VP, Havaki-Kontaxaki BJ, Paplos KG, Pappa DA, Soldatos CR

Department of Psychiatry, Eginition Hospital, University of Athens, 74 Vas. Sophias Ave., 11528, Athens, Greece. pferentinos@med.uoa.gr

We present a case of refractory psychosis with prominent cognitive deficits in a patient with 'mega-cisterna magna', a congenital defect within the 'Dandy-Walker Complex' continuum. The 21-year-old female had a 3-year history of refractory psychotic symptoms despite adequate antipsychotic treatment. CT and MRI scans disclosed 'mega-cisterna magna'. Thorough neuropsychological testing recorded extensive deficits. Treatment with amisulpride 1200 mg/day resulted in a 30% decrease in PANSS score within 2 months. Then galantamine 8 mg/day was added and PANSS score decreased further by 27% within 2 weeks. Cognitive and social functioning was overall much improved. The effect was sustained in a 24 months follow-up. It is postulated that even a less extended cerebellar lesion, such as mega-cisterna magna, can be associated with psychosis, and in some cases with treatment refractoriness or cognitive dysfunction. Adjuvant galantamine may improve cognitive and psychosocial functioning in these patients.

Published 12 February 2007 in Prog Neuropsychopharmacol Biol Psychiatry, 31(2): 561-3.
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