title: Refractory psychosis and prominent cognitive deficits in a patient with mega-cisterna magna.
abstract: 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.
authors.affiliation: Department of Psychiatry, Eginition Hospital, University of Athens, 74 Vas. Sophias Ave., 11528, Athens, Greece. pferentinos@med.uoa.gr
authors.forename: Panayotis P
authors.initials: PP
authors.lastname: Ferentinos
authors.forename: Vassilis P
authors.initials: VP
authors.lastname: Kontaxakis
authors.forename: Beata J
authors.initials: BJ
authors.lastname: Havaki-Kontaxaki
authors.forename: Konstantinos G
authors.initials: KG
authors.lastname: Paplos
authors.forename: Dimitra A
authors.initials: DA
authors.lastname: Pappa
authors.forename: Constantin R
authors.initials: CR
authors.lastname: Soldatos
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000209:etiology* / Q000473:pathology; D003616:Dandy-Walker Syndrome / Q000150:complications* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011618:Psychotic Disorders / Q000209:etiology* / Q000473:pathology