Chiari Causes Psychotic Episode

May 31, 2007

Authors: Ilankovic et al.
University/Hospital: University Clinical Center, Belgrade Serbia and Montenegro
Journal: Psychiatria Danubina 2006

Introduction: Although it has not been researched extensively, most experts believe that Chiari can cause neuropsychological problems, such as depression and trouble with memory and thinking. In addition, one study found that Chiari patients showed abnormal EEG brain activity, even with mild symptoms.

Patient 1: 30 year old woman who suffered from 4 acute, psychotic episodes in the previous three years. The episodes were accompanied by altered consciousness, confusion, disorientation, agitation and insomnia and each episode occurred either during her premenstrual or menstrual period and included epileptic type events. She also showed signs of cranial nerve involvement and reported ringing in the ears. There was no history of infection or head injury which could explain the psychotic episodes and repeated drug and alcohol tests were negative. An EEG showed some irregular brain brain activity and an MRI finally showed a Chiari malformation. The doctors chose to treat the woman with a number of drugs to control her psychotic behavior and epileptic episodes. They also prescribed diuretics and had her restrict her water and salt intake (it appeared that she was only symptomatic due to swelling from water retention). The woman recovered from her episodes after a few days each time and did not remember them.

Authors' Discussion: The authors stress that Chiari can neuropsychological symptoms that vary from person to person and can be intermittent in nature.

Editor's Discussion: This case highlights yet again how varied the symptoms of Chiari can be and is, hopefully, an extreme example of the neuropsychological effects that can accompany the compression and CSF disruption. Undrestanding the neuropsychological impact of Chiari, both cognitive and emotional is critical to improving the experiences and outcomes of patients.

--Rick Labuda