A Case of Right Cerebellopontine-Angle Lesion: Psychotic Symptoms and Magnetic Resonance Imaging Findings

Psychiatry Investig. 2012 September; 9(3): 307–309.
Published online 2012 September 6. doi:  10.4306/pi.2012.9.3.307
PMCID: PMC3440482

A Case of Right Cerebellopontine-Angle Lesion: Psychotic Symptoms and Magnetic Resonance Imaging Findings

Department of Psychiatry, Pusan National University Hospital, Busan, Republic of Korea.
Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea.
Corresponding author.
Correspondence: Byung Dae Lee, MD, PhD. Department of Psychiatry, Pusan National University Hospital, 305 Gudeok-ro, Seo-gu, Busan 602-739, Republic of Korea. Tel: +82-51-240-7304, Fax: +82-51-248-3648, Email: psyleebd@gmail.com
Received October 21, 2011; Revised March 8, 2012; Accepted March 19, 2012.
Copyright© 2012 Korean Neuropsychiatric Association
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Here, we report psychotic symptoms together with a right cerebellopontine-angle lesion. A37-year-old female patient presented with a trigeminal Schwannoma occupying the right cerebellopontine angle. Her psychotic symptoms included auditory hallucinations and delusions of persecution. T1- and T2-weighted images on magnetic resonance imaging (MRI) revealed hyperintense and hypointense areas in the right cerebellopontine angle, respectively. The clinical and neuroimaging reviews in this case suggest that sudden onset of psychotic symptoms at a mature age may be associated with a right cerebellopontine-angle lesion and that MRI should be used to evaluate possible organic bases in patients that present with psychosis.

Keywords: Magnetic resonance imaging, Psychotic symptoms, Cerebellopontine angle

INTRODUCTION

Previous studies have hypothesized that psychiatric symptoms could be major symptoms of cerebellopontine-angle (CPA) lesions,1 specifically in patients with acoustic neuromas in the CPA.24 One report described how a focal temporal-lobe tumor expanded to the CPA and caused postoperativepsychotic symptoms.5 However, in cases where psychotic patients show few or no neurological symptoms, magnetic resonance imaging (MRI) can be an extremely useful tool for evaluating organic lesions; this is often overlooked by psychiatrists. In this paper we reported an adult patient who suddenly developed psychotic symptoms that were associated with a right CPA lesion found on MRI.

CASE

A 37-year-old, right-handed woman visited a psychiatrist after she had experienced persecutory delusions and auditory hallucinations for a month. No specific problems were revealed in the physical examination at admission. During the persecutory delusion she felt that she was being stalked and had recently been wiretapped. She also heard a man’s voice that talked about her behavior, including menstruation and toilet habits. She thought that he had installed closed-circuit television around her house to watch her and followed her on the subway. These symptoms became worse, and she felt that he had invaded her privacy. She was unable to go to the bathroom or eat. When her mother visited her apartment 2 days before admission to the hospital, the windows were covered with newspapers, and the house was full of waste. She described the things that were disturbing her to her mother. She also talked to herself, asking “Why did you follow me to install the cameras?” while crying and smiling.

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