Batmaz Mert, Balçik Zeynep Ezgi, Özer Ürün, Hamurişçi Yalçin Burcu, Özen Şakir
Department of Psychiatry, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey.
Department of Neurology, Bakırköy Prof. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, İstanbul, Turkey.
Noro Psikiyatr Ars. 2017 Sep;54(3):277-281. doi: 10.5152/npa.2017.18114. Epub 2016 Sep 1.
Dandy-Walker malformation is defined by enlarged posterior fossa, cystic dilatation of the fourth ventricle, and cerebellar hypoplasia. Although developmental delay and mental retardation are common in Dandy-Walker malformation cases, other comorbid psychiatric conditions have been rarely reported. There are limited numbers of case reports about comorbidity of bipolar disorder with Dandy-Walker malformation in the literature. Herein, a Dandy-Walker malformation case presenting affective symptoms is reported, and psychiatric symptoms which might be seen in this rare malformation are discussed along with diagnosis, treatment, and follow-up processes. A 27-year-old male patient, hospitalized for compulsory treatment, had been diagnosed with Dandy-Walker malformation in childhood. First complaints were attention deficiency, behavioral problems, learning difficulties; and manic and depressive episodes have occurred during follow-ups. He recently complained of decreased need for sleep, irritability, and increased speed of thought, and psychiatric examination was consistent with manic episode. Cranial computed tomography (CT) revealed bilateral ventriculomegaly, enlarged third and fourth ventricles with posterior fossa cyst, and cerebellar hypoplasia. His treatment included 30 mg/day aripiprazole, 1000 mg/day valproic acid, 200 mg/day quetiapine, 4 mg/day biperiden, and 100 mg/month paliperidone palmitate. Beside its traditional role in the regulation of coordination and motor functions, cerebellum is increasingly emphasized for its involvement in the mood regulation. Thus, as seen in Dandy-Walker malformation, cerebellar anomalies are suggested to play a role in the pathophysiology of mood disorders. Further studies are needed to better understand the relationship between mood disorders and cerebellum. Moreover, treatment options should be considered carefully in terms of resistance to treatment and potential side effects, for psychiatric disorders occurring in these cases; and detailed examinations, including cranial imaging, would be beneficial in bipolar cases with early onset, unresponsiveness to treatment, presenting atypical symptoms, mental retardation, and developmental delay as well as neurological symptoms and signs.
Dandy-Walker畸形的定义为后颅窝增大、第四脑室囊性扩张以及小脑发育不全。虽然发育迟缓与智力障碍在Dandy-Walker畸形病例中很常见，但其他合并的精神疾病鲜有报道。文献中关于双相情感障碍与Dandy-Walker畸形共病的病例报告数量有限。在此，报告一例出现情感症状的Dandy-Walker畸形病例，并讨论这种罕见畸形可能出现的精神症状以及诊断、治疗和随访过程。一名27岁男性患者因强制治疗入院，童年时被诊断为Dandy-Walker畸形。最初的症状为注意力缺陷、行为问题、学习困难；随访期间出现过躁狂和抑郁发作。他最近抱怨睡眠需求减少、易激惹以及思维速度加快，精神检查符合躁狂发作。头颅计算机断层扫描（CT）显示双侧脑室扩大、第三和第四脑室增大伴后颅窝囊肿以及小脑发育不全。他的治疗包括每天30毫克阿立哌唑、每天1000毫克丙戊酸、每天200毫克喹硫平、每天4毫克安坦以及每月100毫克棕榈酸帕利哌酮。除了在调节协调和运动功能方面的传统作用外，小脑在情绪调节中的作用日益受到重视。因此，正如在Dandy-Walker畸形中所见，小脑异常被认为在情绪障碍的病理生理学中起作用。需要进一步研究以更好地理解情绪障碍与小脑之间的关系。此外，对于这些病例中出现的精神疾病，在考虑治疗抵抗和潜在副作用方面应仔细权衡治疗选择；对于早发、治疗无反应、出现非典型症状、智力障碍、发育迟缓以及伴有神经症状和体征的双相情感障碍病例，包括头颅影像学检查在内的详细检查将是有益的。
