Case Report: Atypical psychotic onset of type I Arnold-Chiari

We report a case of type I Arnold-Chiari malformation that is very Introduction: peculiar because of its particular onset especially characterized by psychiatric symptoms. These symptoms were so prevailing that, for fifteen years, they masked the neurological aspects and the patient was treated with high doses of psychotropic drugs without any benefit. If the Arnold-Chiari malformation had been diagnosed before the development of severe hydro-syringomyelia, the patient could have underwent decompressive neurosurgery which may have improved her quality of life. It is worthwhile to highlight that psychotic symptoms may be caused by this congenital malformation, that typically has an aspecific onset. Therefore it’s important to consider an eventual organic etiology while challenging a resistant clinical picture with unusual presentation. A 51-year-old woman reported neurological symptoms Case description: consisting of headaches, blurred vision, diplopia, tinnitus, vertigo and psychiatric symptoms including obsessive ideas about the fear of killing her son, auditory and visual pseudo-hallucinations. The symptoms had developed suddenly at the age of 35 years and persisted thereafter. She underwent multiple hospitalizations in psychiatric units and was treated with a variety of psychopharmacological approaches without substantial improvement. We performed a brain MRI that identified a type I Arnold-Chiari malformation. We assessed psychiatric symptoms using the Structured Clinical Interview for DSM IV Axis I Disorders, the Brief Psychiatric Rating Scale, and the Yale-Brown Obsessive-Compulsive Scale. A tailored psychopharmacological therapy led to a partial improvement in mood and anxiety but not in hallucinations. We want to highlight how important is, in everyday psychiatric Discussion: clinical practice, not to focus only on psychiatric aspects but consider the patient globally, because in this case psychiatric problems were the onset presentation of a rare neurological syndrome. Chiara Di Genova ( ) Corresponding author: [email protected] Di Genova C, Charitos S, Ba G and Viganò CA. How to cite this article: Case Report: Atypical psychotic onset of type I Arnold-Chiari 2015, :915 (doi: ) malformation [version 1; referees: peer review discontinued] F1000Research 4 10.12688/f1000research.6975.1 © 2015 Di Genova C . This is an open access article distributed under the terms of the , Copyright: et al Creative Commons Attribution Licence which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The author(s) declared that no grants were involved in supporting this work. Grant information: Competing interests: No competing interests were disclosed. 28 Sep 2015, :915 (doi: ) First published: 4 10.12688/f1000research.6975.1 28 Sep 2015, :915 (doi: ) First published: 4 10.12688/f1000research.6975.1 28 Sep 2015, :915 (doi: ) Latest published: 4 10.12688/f1000research.6975.1 v1 Page 1 of 3 F1000Research 2015, 4:915 Last updated: 13 APR 2017