1 - Pedopsiquiatria, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
2 - Psiquiatria da Infância e Adolescência, Hospital Fernando da Fonseca, Lisboa
- Poster no European College of Neuropsychopharmacology Congress 2020
Resumo:
Background: Psychotic disturbance can be due to functional or organic conditions, with arachnoid cysts included in the last. Arachnoid cysts are a benign congenital malformation, accounting for about 1% of space occupying lesions. Their finding is usually accidental. The posterior fossa is the second most common location after the midlle cranial fossa. Altough the vast majority of arachnoid cysts are asymptomatic, in recent years they have been suspected to be the organic cause of psychiatric illness. Psychosis can be the only clinical manifestation of the cyst. Treatment may differ and must be individualized and may envolve pharmacological therapy or surgery. Risperidone was found to be effective. Case reports regarding the presence of arachnoid cysts and psychiatric disorders are scarce but increasing, therapeutic approach should be considered in younger ages.
Objective: Review pharmacological approaches in the treatment of schyzophrenia-like psychotic disorder with coexistent arachnoid cyst , in patients of pediatric age.
Methods: The authors conducted a literature (‘medline’) review with the following keywords: ‘arachnoid cyst’, ‘psychosis’, ‘ child’.
Results: Few repports were found in the available literature and the vast majority discussed adult patients - even if most arachnoid cysts are often diagnosed before adulthood. However, one case report presented the treatment of a 9 year-old child with posterior fossa retrocerebellar arachnoid cyst. Interestingly, the drug used was aripiprazole, with good progress.
Conclusion: The link between arachnoid cysts and psychotic disorders is no very clear. Considering surgery, it is regarded a high treatment option with not established guidelines, specially in pediatric ages, apart from progressive hydrocephaly and intracranial hypertension However, there have been cases in wich total remission of psychotic symptoms after the cyst have been removed. Conservative medical management is usually the preferred approach, with many cases relying on antipsychotic drug risperidone – in adults. Risperidone is usually selected as a drug of choice. Not always the pharmacological treatment is succesfull, emphasizing the probable organic nature of the psychotic disorder. Even if rare, further studies are necessary to evaluate efficiency of risperidone or other antipsychotics in patients with arachoidal cysts in order to optimise the therapeutic approach – specially in paediatric patients.
Palavras Chave: arachnoidal cyst, risperidone, psychotic disorders, children