| 제목 |
Psychosis Caused by Limbic disconnection |
| 소속 |
Yeouido St. Mary’s Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Youngkook Kim1*†, Sun Jae Won1, Yeun Jie Yoo1*, DaYe Kim1, Mi-Jeong Woon1 |
Background: Injury to the limbic system can result in amnesia, language difficulties, behavioral abnormalities, and psychological disorders. We present a patient who suffered psychosis related to disconnection of the limbic system after intraventricular and orbitofrontal hemorrhages following removal of a sellar meningioma.
Case Description: A 23-year-old male presented with left homonymous hemianopia and underwent a brain MRI that revealed a sellar meningioma. He underwent a craniotomy with tumor removal via a subfrontal transbasal approach. However, a postoperative intraventricular hemorrhage involving lateral ventricle accompanying a left orbitofrontal hemorrhage occurred 1 day later. After 4 weeks, unexpected bizarre behaviors and hallucinations were emerged on the recovery course of cognitive dysfunction. Diffusion tensor tractography was performed to evaluate the entire limbic system for the differential diagnosis of psychosis caused by organic brain injury. The tractography results showed degeneration of the fornix, left cingulum, mammillothalamic tract and uncinate fasciculus. These findings were corresponded to the manifestations of psychosis, anterograde amnesia, and anomic aphasia. The follow-up tractography revealed the regenerating limbic tracts that coincided with the recovery of clinical symptoms after 14 weeks.
Conclusions: The neuropsychiatric problems could result from disconnection of the limbic system following a postoperative intraventricular hemorrhage. Diffusion tensor tractography was valuable for evaluating the integrity of the injured limbic tracts and determining the regeneration of tracts corresponding to neuropsychiatric recovery |
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