Neuropsychiatric Manifestations of Partial Agenesis of the Corpus...
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Case ReportNeuropsychiatric Manifestations of Partial Agenesis ofthe Corpus Callosum: A Case Report and Literature Review
Olusegun Popoola ,1 Olaniyi Olayinka ,1 Heela Azizi ,2
Chiedozie Ojimba,1 Tasmia Khan,3 Jisha Kallikkadan,4 Maleeha Ahmad,2
Joshua Jay,5 Cecilia Canale ,4 Sherina Langdon,2 Alexa Kahn,2
Deepa Nuthalapati,2 Sinthuja Jayaraj,2 Ayesha Mahbub,1 Olalekan Olaolu,1
Kodjovi Kodjo,1 Tolu Olupona,1 Carolina Nisenoff,1 and Ayodeji Jolayemi1
1 Interfaith Medical Center, New York Department of Psychiatry, Brooklyn, NY, USA2American University of Antigua College of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA3Medical University of the Americas, Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA4Extern, Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA5St. Matthews School of Medicine, Department of Psychiatry, Interfaith Medical Center, Brooklyn, NY, USA
Correspondence should be addressed to Olusegun Popoola; [email protected]
Received 20 January 2019; Accepted 6 March 2019; Published 25 March 2019
Academic Editor: Erik Jonsson
Copyright © 2019 Olusegun Popoola et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.
Agenesis of the corpus callosum is a rare congenital defect that has been linked to psychiatric disorders, cognitive deficits, learningdisabilities, and developmental delays. We present the case of a patient with partial agenesis of the corpus callosum who exhibitsdepressed mood, transient loss of memory, and history of cognitive, social, and behavioral disturbances that developed during hischildhood. Recent and pertinent literaturewas reviewed and the agenesis of the corpus callosum and its associated neuropsychiatricmanifestations are discussed.
1. Introduction
The implication of the partial agenesis of the corpus callosumin the development and manifestations of a psychiatricdisorder is not fully understood. The corpus callosum is themost massive white matter structure in the brain that isinvolved in the exchange of information between the cerebralhemispheres. The corpus callosum develops between theeighth and 20th week of pregnancy, and its developmentcan be halted during this period [1]. Complete or partialagenesis can occur as part of a syndrome or in isolation [1].Nonsyndromic isolated agenesis of the corpus callosum canbe asymptomatic. However, the prevalence of asymptomaticcases is not known. The incidence of agenesis of the corpuscallosum has been reported to be between 0.05 and 0.7percent of the general population with a male predominance[1]. Despite the proximity of the corpus callosum to the
cingulate gyrus, which plays a critical role in the regulationof mood, the implication of its anomaly is yet to be clearlyunderstood. Some neuropsychiatric manifestations such asunipolar depression, bipolar depression, schizophrenia, andsevere behavior problems have been linked to the agenesis ofthe corpus callosum, further making the actual correlation ofcorpus callosum anomalies to psychiatric disorders unequiv-ocal [2, 3].
These neuropsychiatric disturbances notably observedin patients with corpus callosum anomalies have raisedquestions regarding the effect of corpus callosum atrophyand agenesis. The current literature demonstrates potentialassociations between features of psychosis and corpus callo-sum degeneration or agenesis [4–6]. Previous research hasshown some disruption of emotional processing in patientswith corpus callosum irregularities [7]. Patients have alsobeen shown to have a potential predisposition to psychosis
HindawiCase Reports in PsychiatryVolume 2019, Article ID 5925191, 8 pageshttps://doi.org/10.1155/2019/5925191
2 Case Reports in Psychiatry
in the case of agenesis of the corpus callosum, andmany havespecifically experienced delusions [4, 5].Though the researchin patients with corpus callosum agenesis is expanding,many questions are unanswered. The research highlightssome psychotic symptoms and emotional dysregulation butis lacking in outlining common symptomatology of cor-pus callosum atrophy and agenesis. As of yet, there areno well-defined syndromic classification of corpus callo-sum pathology. In this report, we aim to discuss corpuscallosum pathology as a grouping of specific psychiatricmanifestations.
2. Case Presentation
We describe the case of a 45-year-old Hispanic man whopresented to the psychiatric emergency room on accountof depressed mood and forgetfulness. He was found by hisniece sitting in the bathroom batting away imaginary fliesand crying, stating that he could not remember anythingwhich prompted his niece to call emergency medical services(EMS).
The patient was emotionally labile and could not remem-ber his name or address at the time of presentation. He washyperverbal and difficult to interrupt, and his speech wasdisorganized. The patient stated that prior to admission, heleft his home and suddenly could not remember how he gotto the location he had traveled to. He then returned homeand entered the bathroom to look for a belt to hang himselfwith, because he could not remember any of the evening’sevents. He stated that he felt lonely and helpless and that hehad suicidal thoughts. The patient stated that his sleep hadbeen poor. He endorsed a perceptual disturbance of seeingfleas that were trying to infest his body. He also endorsedan auditory hallucination of a male voice calling his name.Collateral information from his niece, who called the EMS,revealed that the patient had been acting bizarre with twoprevious episodes of new-onset wandering behavior in thepast six months, both associated with heavy alcohol use.She also reported that the patient had a 15-year history ofschizophrenia and that he had had similar episodes in thepast, which were usually brief and resolved without the needfor hospitalization. During a similar episode three years ago,the patient began attacking his family members and was hos-pitalized after the police were called.The patient also receiveda diagnosis of major depressive disorder five years ago. Thepatient was admitted to the inpatient psychiatry unit with adiagnosis of major depressive disorder. Urine toxicology atthe time of admission was negative for controlled substances,illicit drugs, and alcohol. The patient’s admission CompleteBlood Count (CBC) and kidney liver function tests werewithin normal limits. Rapid regain test was negative. Serumsodium and potassium were 138mmol/L (136–144.0mmol/L)and 4.4mmol/L (3.6–5.1), respectively. Other routine urineanalyses and coagulation profiles were also within normallimits as were routine chest radiograph and ECG. Serumthyroid stimulating hormone was below the lower limit ofnormal 0.409 uIU/ml (0.450–4,500 uIU/ml) and free T4 was1.09 ng/ml (0.82–1.77 ng/dL). The patient had no symptomsof hyperthyroidism.
Figure 1: MRI demonstrating partial agenesis of the corpus callo-sum with the absence of the posterior body and the splenium.
Other chemical laboratory investigations were withinnormal limits except for dyslipidemia. Computerized tomog-raphy (CT) and magnetic resonance imaging (MRI) per-formed during admission revealed partial agenesis of thecorpus callosum with the absence of the posterior body andthe splenium as shown in Figure 1.
On day 1 of hospitalization, the patient was hyperactiveand restless on the unit. He was treated with escitalopram10 mg PO daily and risperidone 2 mg PO BID. By day 2 ofhospitalization, the patient was able to recall his name and hisperceptual disturbances resolved, but hewas still hyperverbal,with increased activity. By day 9 of hospitalization, thepatient’s condition had stabilized, and he was discharged.
According to the patient’s mother, the pregnancy wasreported to be complicated at five months, and the patientwas born at seven months. He had normal gross motor devel-opment, but language was delayed until the age of 7 years.The mother reported a history of cognitive developmentaldelay and intermittent behavioral disturbances that led to hisdropping out of school in fifth grade.
3. Literature Review
We conducted a literature review to explore various neu-ropsychiatric manifestations of agenesis of the corpus cal-losum presented in this case report. This was focused onidentifying peer-reviewed articles related to partial agenesisof the corpus callosum and pathology. We searched PubMed,EBSCO, and Web of Science for articles on the function ofthe corpus callosum and presentation when absent or whenthere is a lesion without language restriction or restriction totime-period. The search was conducted using the keywordsand MeSH terms: “function” “agenesis” “corpus callosum”,“schizophrenia”, and “psychosis.” Screening for eligible arti-cles was conducted independently by six authors. Eligiblestudies were those that focused on the symptomatology ofagenesis of the corpus callosum or defect in the corpuscallosum and the respective psychiatric manifestations inhuman subjects. The citation manager used was Endnote inorder to prevent duplication of references.
Case Reports in Psychiatry 3Ta
ble1:Re
view
ofselected
literatureo
ncaseso
fpatientsthatp
resented
with
corpus
callo
sum
patholog
y.
Article
Gender
Age
Sign
sand
Symptom
sLabFind
ings/Im
agingStud
ies
Agenesis
ofCorpu
sCallosum
and
EmotionalInformationProcessin
gin
Schizoph
renia[
7]F
23
(i)ritualsof
washing
herh
ands
andclotheso
utof
fear
ofgerm
s(ii)c
ollected
issuesfrom
“People”
magazine,
predom
inantly
oftheA
merican
singer,MariahCarey
(iii)megalom
aniacald
elusio
nin
regard
toMariah
Carey,w
ithwho
msheb
elievedwas
herfrie
ndand
confi
dante
(iv)p
ersecutio
nbelief:everyone
arou
ndherw
asconspirin
gagainsth
er,w
ishingherill,resulting
inher
tofleethe
cityto
escape
herp
ersecutors
(v)v
isualdisto
rtions
andhallu
cinatio
ns
MRI
-partia
lagenesis
ofthec
orpu
scallosum,abo
vetheg
enuandsurrou
ndingthem
idlin
e,inclu
ding
the
isthm
usandanterio
rhalfo
fthe
splenium
.Lateral
ventric
lesw
erelarge,especially
poste
riorly
,extending
into
theo
ccipita
llob
e.fM
RI-m
orelateralized
and
spatially
localized
activ
ation,whenthee
motional
contento
fthe
stimuliw
asconsidered
Delu
sionalD
isorder
inaP
atient
with
Corpu
sCallosum
Agenesis
[8]
F23
(i)parano
idandpersecutoryd
elusio
nsagainsth
erbrothera
ndmother,speaking
illabou
ther
character
andconspirin
gto
killher
(ii)d
elusio
nof
reference
(iii)abusivea
ndassaultiv
e,e.g
.,started
breaking
expensiveh
ouseho
lditems
(iv)p
oora
ppetite
anddifficulty
falling
asleep,sleeping
abou
t3-4
hours
MRI
ofbrain-a
genesis
ofthec
orpu
scallosum,septum
pellu
cidu
mwith
bilateralseptalcolpo
ceph
aly
Severe
psychiatric
distu
rbance
and
abno
rmalities
ofthec
orpu
scallo
sum:reviewandcase
serie
s[5]
Pt1:F
Pt2:M
Pt3:M
Pt4:M
Pt5:M
Pt6:M
Pt7:F
Pt1:35
Pt2:29
Pt3:41
Pt4:33
Pt5:22
Pt6:12
Pt7:31
Pt1:persecutoryd
elusio
ns,aud
itory
andvisual
hallu
cinatio
ns,depression,
andthou
ghtd
isorder
Pt2:chronics
chizop
hrenia,delu
sions,tho
ught
disorder,aud
itory
andvisualhallu
cinatio
ns,and
epilepsy
Pt3:manicdepressiv
epsychosisandepilepsy
Pt4:acutea
nxiety
statewith
auditory
andvisual
hallu
cinatio
nsPt
5:schizoid
person
ality
Pt6:severe
behavioralprob
lems
Pt7:person
ality
disorder
with
depressiv
eand
conversio
nsymptom
sand
epilepsy
Pt1:CT
-lipom
ainthep
osterio
rcorpu
scallosum.E
EGperfo
rmed
twicea
tage
30;secon
dshow
edsomem
inor
dysfu
nctio
nPt
2:CT
-agenesis
ofcorpus
callo
sum,left
hemi-a
troph
yof
anterio
rhem
isphere
duetoa
CSF-containing
frontallobe
cyst,
andwidened
third
ventric
le.EEG
-abn
ormalwith
sharpwaves
over
tempo
ralregions
Pt3:CT
andMRI
-agenesis
ofthea
nteriorc
orpu
scallo
sum.E
EGs-
burstsof
generalized
rhythm
icdelta
activ
ityandleftanterio
rquadrantd
ysfunctio
nPt
4:CT
-partia
lagenesis
ofthea
nteriorc
orpu
scallo
sum.E
EGs-
norm
alPt
5:CT
-lipom
ainthes
plenium
ofthec
orpu
scallo
sum.E
EG-slowactiv
ityPt
6:CT
-partia
lagenesis
ofthec
orpu
scallosum
with
mod
erately
largelipom
a,sm
allp
oorly
defin
edcaud
ate
nuclei,and
dilatedtempo
raland
poste
riorh
orns
ofthe
third
ventric
le.EEG
-normal
Pt7:CT
-agenesis
ofthec
orpu
scallosum
andthe
lateralventriclesw
eres
eparated
byan
expand
edthird
ventric
le.EEG
was
norm
al.
Agenesis
ofcorpus
callo
sum
and
psycho
sis-reviewandcase
descrip
tion[9]
N/A
43Neuropsycho
logicalinvestig
ationrevealed
mild
mental
retardation
CTandMRI
-partia
lagenesis
ofthec
orpu
scallosum
EEG-n
ormal
4 Case Reports in Psychiatry
Table1:Con
tinued.
Article
Gender
Age
Sign
sand
Symptom
sLabFind
ings/Im
agingStud
ies
Agenesis
ofthec
orpu
scallosum
with
associated
inter-hemisp
heric
cystandrig
htfro
ntalpachygyria
presentin
gwith
psychiatric
symptom
sinaK
enyan[10]
M26
(i)depressio
nandrecurrence
ofseizures
(ii)n
ormalgeneraland
neurologicalexam
inationapart
from
somefrontallobe
signs
onmentalstatus
exam
ination
(iii)psycho
sisandlabilemoo
d
CT-a
genesis
ofthec
orpu
scallosum
with
inter-hemisp
heric
cystandrig
htfro
ntalpachygyria.N
ofatd
ensitycouldbe
identifi
edin
them
idlin
eusin
gHou
nsfield
Units.
CBC,
EEG-n
ormal
Agenesis
oftheC
orpu
sCallosum
[11]
MMiddle
Aged
(i)parano
iddelusio
ns:doctors,nursin
gsta
ff,and
patie
ntsw
erea
gainsthim
(ii)a
udito
ryhallu
cinatio
ns:voices,bo
thmalea
ndfemale,warning
him
ofthed
octors,hiswife
was
being
unfaith
ful,andhisd
eath
Imaging-a
genesis
ofthec
orpu
scallosum
Acutep
sychoticsymptom
s:a
manifesta
tionof
antip
hospho
lipid
synd
romeo
rinfarctionof
corpus
callo
sum
[12]
F25
(i)sle
eplessness,excessiv
etalking
(ii)p
ersecutory
parano
idsymptom
s(iii)auditory
hallu
cinatio
ns,com
mentary
voices
and
voices
conversin
gwith
each
other
Weigh
tedT2
MRI
-sagittalsections
show
edhyperin
tenselesions
inthes
plenium
ofthec
orpu
scallo
sum
duetoan
acuteinfarctionfro
mthrombo
sisdu
etoantip
hospho
lipid
synd
rome.
Corpu
scallosum
atroph
yand
psycho
sis:a
case
repo
rt[13]
M31
(i)delusio
nsof
persecution
MRI
-cerebralatro
phyin
thefrontop
arietalzon
e,no
n-specificg
liotic
whitematterc
hanges1,andatroph
iccorpus
callo
sum.
Neuropsycho
logicaltests(e.g.,Stroop
test,
clock-draw
ingtest)-n
ormal
Cognitiv
eimpairm
entsassociated
with
corpus
callo
sum
infarctio
n:a
tencasesstudy
[14]
10Pts:M
42-73
(i)im
pairm
ento
fmem
ory,attention,planning
,ability
tolearnnewthings,orie
ntation,
calculation,lang
uage,
andrepetition;Nopsychiatric
manifesta
tions
MRI
serie
s(T2
W1,T2
W2,FL
AIR,D
WI)-c
orpu
scallo
sum
infarctio
n
Cognitiv
e,Be
havioral,and
Psychiatric
Symptom
sinTw
oCh
ildrenwith
Agenesis
ofthe
Corpu
sCallosum:C
aseR
eport[15]
Pt1:M
Pt2:F
Pt1:11
Pt2:10
Pt1:predom
inantly
visualhallu
cinatio
nsover
auditory
hallu
cinatio
ns.A
ppearedtensea
ndconfused,w
ithspeech
impairm
ent.Lacked
insig
htandcogn
ition
.Drawings
exem
plified
thep
resenceo
fanx
ietyand
visualperceptualdelays.
Pt2:good
person
alhygiene,anxiou
s,andmostly
coherent
speech.N
odelusio
nsor
hallu
cinatio
ns.
Pt1:no
rmalneurologicalexam
ination,except
forsoft
neurologicalsig
ns.E
EG-p
resenceo
fpartia
lcom
plex
seizures.
Pt2:Psycho
logicaltestin
g-fullscaleIQ
of102,AT
RSscoreo
f28.EE
G-intermittentslowing,with
occasio
nal
high
amplitu
desharpwaves
ontheleft
occipital
region
s.Noevidence
ofclinicalseizures.M
RI-p
artia
lAC
C,predom
inantly
ther
ostrum
andtheb
ody,and
colpocephaly.
Thyroidfunctio
nstu
dies,u
rine
metabolic,aminoacid,and
organica
cidscreensw
ere
norm
al.
Develop
mentalA
bnormalities
oftheC
orpu
sCallosum
inSchizoph
renia[
16]
Pt1:M
Pt2:F
Pt1:39
Pt2:33
Pt1:visualandauditory
hallu
cinatio
ns,tellin
ghim
tokillhimself,
since
child
hood
.Pt
2:Persecutoryd
elusio
nsthatledhertoattempt
tokillherselfb
eforeh
erpersecutors“dism
embered”
her
anddisplayedhero
nthe“
John
nyCarsonSh
ow”.
Positives
ymptom
swerer
efractorytotre
atment.
Pt1:T1
weighted
MRI
-mid-sagittalim
age,almost
completea
bsence
ofthec
orpu
scallosum
Pt2:T1
weighted
MRI
-lipom
ainvolving
thee
ntire
corpus
callo
sum
Case Reports in Psychiatry 5
Table1:Con
tinued.
Article
Gender
Age
Sign
sand
Symptom
sLabFind
ings/Im
agingStud
ies
Agenesis
ofthec
orpu
scallosum
and
schizoph
renia:Acase
repo
rt[17]
M55
(i)increasin
glyirr
itablew
ithpersecutoryd
elusio
nstowards
hisp
arents
(ii)w
ithdraw
n,believedto
bepersecuted
asa
“hom
osexual”atwo
rk(iii)distr
essedby
persistentaud
itory
hallu
cinatio
nsof
several“mum
bling”
voices
which
originated
from
with
inandou
tside
hisb
ody
(iv)d
elusio
nsof
reference,believing
thatpeop
lewe
relaug
hing
andsta
ringathim,and
televisio
nprograms
referred
tohim
(v)n
odistu
rbance
oflang
uage
ormoo
d
CT-a
bsentcorpu
scallosum,m
idlin
ecystic
space
extend
ingup
wardfro
mthethird
ventric
le,and
dilated
occipitalh
orns
oflateralventricles.MRI
-com
plete
absenceo
fthe
corpus
callo
sum,present
anterio
rcommissure,andlargeC
SFfilledcavityin
theleft
frontotem
poralregion,
which
extend
stothev
ertex,
apparentlycommun
icatingwith
thev
entricular
syste
m.
Acase
ofschizoph
reniaw
ithcompletea
genesis
ofthec
orpu
scallo
sum
[18]
F24
(i)auditory
hallu
cinatio
ns,voiceso
fangelsa
ndthe
devil
(ii)e
rotic
delusio
ns,dire
cted
atam
ales
choo
lteacher
(iii)otherd
elusio
ns:losingab
abywith
everym
enstr
ual
cycle
CTandMRI
-com
pletea
genesis
ofthec
orpu
scallo
sum,w
ithcolpocephaly,
asun
burstg
yralpatte
rnandah
igh-rid
ingthird
ventric
le.
Corpu
sCallosum
Agenesis
and
Psycho
sisin
And
ermannSynd
rome
[19]
31Pts:F
31Pts:M
3-36
(i)visualhallu
cinatio
ns,persecutory
andparano
idtype,
auditory
hallu
cinatio
ns,and
parano
iddelusio
ns
Unspecifiedlab/im
agingstu
dy-4
0of
62patie
nts
presentedwith
corpus
callo
sum
agenesis,
35caseso
ftotaland
5of
partialagenesis.10of
40patie
nts
presentedwith
poste
riorfossa
atroph
y.Corpu
scallosum
shapea
lteratio
nsin
individu
alsp
riortotheo
nsetof
psycho
sis[20]
100Pts:
M&F
14-30
(i)27
outo
f100
patie
ntsd
evelop
edap
sychoticillness
T1we
ighted
MRI
-Mid-sagittalslice
show
edredu
ced
thickn
esso
fthe
anterio
rgenuof
thec
orpu
scallosum
inthe2
7symptom
aticpatie
nts
Meta-analysisof
magnetic
resonanceimagingstu
dies
ofthe
corpus
callo
sum
inschizoph
renia
[21]
MandF
10-71
(i)sig
nsandsymptom
srelated
todisordersinthe
schizoph
reniad
isorder
spectrum
orschizotypal
person
ality
disorder
MRI
-callosalareas
ofschizoph
renicp
atientso
verthe
healthyun
relatedcontrolp
atients,course
oftheilln
ess
influ
encedthes
ize
6 Case Reports in Psychiatry
Table1:Con
tinued.
Article
Gender
Age
Sign
sand
Symptom
sLabFind
ings/Im
agingStud
ies
Thec
orpu
scallosum
inschizoph
renia-volumea
ndconn
ectiv
itychangesa
ffectspecific
region
s[22]
12pts:M
12pts:F
29-49
(i)chronicp
aranoidschizoph
reniaw
hich
was
confi
rmed
with
structuredclinicalinterviews.
DTI
brainim
age-
mid-sagittalslices,corpus
callo
sum
segm
entatio
nin
3patie
nts.Vo
lumea
ndfractio
nal
aniso
tropy
were
positively
correlated
inbo
thcontrols
andpatie
nts.Fractio
nalanisotro
py,m
eandiffu
sivity,
andvolumew
eren
egatively
correlated;how
ever,all
threem
easuresw
ereh
ighlycorrelated
with
one
another.Th
ecorpu
scallosum
region
sweren
otall
affectedequally
orthes
ameb
ythea
natomicalchange.
Marchiafava-BignamiD
isease
Presentin
gas
AcuteP
sychosis[23]
M32
(i)agitatio
n,confusion,
delirium,dysarthria
,dem
entia
,psycho
ticsymptom
s,andothern
europsychiatric
manifesta
tions.
CT-h
yperdenselesionof
thec
orpu
scallosum.M
RI-
hyperin
tenselesionwith
restr
icteddiffu
sionof
the
corpus
callo
sum.
Clinicalandradiologicalfeatures
ofMarchiafava-Bignamidise
ase[24]
9pts:M
37-62
(i)behavioraldisorder,seizures,cogn
itive
impairm
ent,
delirium,dysarthria
andothern
eurologicalsym
ptom
s.
Pt1:MRI
–extend
edlesio
nsin
thes
plenium
ofthe
corpus
callo
sum.
Pt2:Pt
1:MRI
–circum
scrib
edlesio
nsin
thes
plenium
ofthec
orpu
scallosum
Pt3:Pt
1:MRI
–extend
edlesio
nsin
theg
enu,bo
dy,and
splenium
ofthec
orpu
scallosum.
Pt4:Pt
1:MRI
–extend
edlesio
nsin
thes
plenium
ofthe
corpus
callo
sum
Pt5:Pt
1:MRI
–ovoidlesio
nsin
thes
plenium
ofthe
corpus
callo
sum
Pt6:Pt
1:MRI
–extend
edlesio
nsin
thes
plenium
ofthe
corpus
callo
sum
Pt7:Pt
1:MRI
-extendedlesio
nsin
thes
plenium
ofthe
corpus
callo
sum
Pt8:Pt
1:MRI
–lobu
latedlesio
nsin
theb
ody,and
splenium
ofthec
orpu
scallosum
Pt9:Pt
1:MRI
-extendedlesio
nsin
thes
plenium
ofthe
corpus
callo
sum
“M”,males;“F”,fem
ales;“Pt”,patient;“MRI”,magnetic
resonanceim
aging;
“fMRI”,Fu
nctio
nalm
agnetic
resonanceim
aging;
“CT”
,com
putedtomograph
y;“D
TI”,diffu
siontensor
imaging,
“CBC
”,complete
bloo
dcoun
t,“A
TRS”
abbreviatedteacherratingscale,“A
CC”,agenesisof
thec
orpu
scallosum,“EE
G”,electro
enceph
alograph
,and
“IQ’,intelligence
quotient.
Case Reports in Psychiatry 7
Because of the rarity of agenesis of the corpus callosum,all types of studies were considered for analysis includ-ing experimental, meta-analysis, cohort, case-control, caseseries, and case reports. The pertinent information fromthe included articles was abstracted and entered into adata abstraction form using Microsoft Excel constructed bythe group. The information extracted from eligible articlesincludes the title of the article, gender and age of the patient,signs, symptoms elicited, and lab findings/imaging recorded.
A summary of the cases from the review of literature isshown in Table 1. Table 1 covers the already published cases ofpatients that presented with corpus callosum pathology andtheir respective symptoms. All the reviewed studies reportedthe gender of patients with 56 percent being male and 44percent female. The ages of the subjects ranged from 3 to 73years; the mean age was 33 years. Furthermore, out of the 15patient in the reviewed case reports and case series identifiedto have either a partial or complete agenesis of the corpuscallosum about 36 percent were female and 64 percent weremale.
Reported symptoms ranged from changes to behaviorand personality, including paranoia, hallucinations, and delu-sions, to cognitive impairment. Radiological findings of thepatients varied; however it mainly included agenesis oratrophy of the corpus callosum, followed by lipoma of thecorpus callosum.
4. Discussion
The case presented is a patient with partial agenesis ofcorpus callosum with a previous diagnosis of schizophreniaand recurrent transient loss of memory, who presentedwith mood disorder which resolved within two days duringtreatment with a combination of antidepressants and antipsy-chotics. Other probable nonpsychiatric contributors to thispresentation were ruled out in the context of normal labora-tory findings and the findings from neurologic examination.
Lesions in the corpus callosum have been implied in theetiology of psychiatric disorders; however, the pathophysio-logic mechanism is not understood. Studies have shown thatthe size or thickness of the corpus callosum area is smallerin individuals with schizophrenia when compared to thosewithout schizophrenia [20–22]. Furthermore, a defect in thecorpus callosum has been recognized in the neuropathologyfeature of some neurologic disorders which presents withpsychotic symptoms [23, 24].
Research has suggested that “asymptomatic” individualswith agenesis of corpus callosum (ACC) nevertheless haveareas of specific cognitive deficit or learning disability [4].As of yet, the pattern of consistent cognitive deficits in ACChas not been fully described. It is not clear if the partialACC in our patient contributed to his cognitive, social,and behavioral disturbances that date back to his child-hood. Results from research literature, however, suggest thathigh-functioning adults with ACC typically have moderatebut detectable deficits in the following areas: interhemi-spheric transfer of complex sensory information and learn-ing; bimanual motor coordination; complex novel problem-solving; processing of subtle phonetic and semantic aspects
of language; comprehension of second-order meanings oflanguage; and psychosocial understanding and behavior [4].
5. Conclusion
Agenesis of the corpus callosum is a rare condition thatis commonly known to be associated with seizures, devel-opmental delays in motor and language skills, and sensoryimpairment. In addition to these symptoms, there have beenmultiple findings supporting the association between ACCand neuropsychiatric manifestations such as depression,schizophrenia, bipolar disorder, learning deficits, epilepsy,and conversion symptoms. The findings from our case pre-sentation further support that there is a connection betweenACCand the onset ofmood and psychotic symptoms. Corpuscallosum anomalies interfere with the communication andregulation of activity between the two hemispheres andmanifest with these abnormal symptoms. Further studiesof mental disorders in patients with ACC are necessary toincrease our understanding and awareness of the cerebralbasis of many mental health conditions.
Consent
The patient’s consent was obtained.
Conflicts of Interest
The authors have no conflicts of interest to declare.
Authors’ Contributions
All authors have participated in the procurement of thisdocument and agree with the submitted case report.
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