Neuropsychological and psychiatric complications in endoscopic third ventriculostomy: a clinical case report
- aInstitut Clínic de Psiquiatria I Psicologia. Hospital Clínic de Barcelona, Facultat de Medicina de la Universitat de Barcelona, C/ Villarroel 170; 08036 Barcelona, Spain, bDepartment of Neurosurgery. Vall d'Hebron University Hospitals. Barcelona, Spain, cCentred salut mental, SAAS, Andorra, Spain
- Dr A Benabarre31555abh{at}comb.es
- Received 29 December 1999
- Revised 27 October 2000
- Accepted 7 February 2001
Abstract
The clinical case report of a patient who underwent an endoscopic third ventriculostomy for the treatment of a slit ventricle syndrome is presented. After surgery the patient developed a severe complication consisting of an organic personality disorder, characterised by impulsiveness, physical heteroaggressiveness, binge eating, hypersomnia and impairment of memory, and frontal-executive functions.
A frontal lobe lesion may explain some of the symptoms presented, such as the uncontrolled impulses, the aggressive behaviour, and even the binge eating. However, a longitudinal neuropsychological evaluation showed a severe deficit in immediate memory and difficulties in planning and consolidation of newly learned information, which may be best related to damage in the frontal basal structures of the brain: the fornix and its connection to the hippocampus and the mamillary bodies. Postoperative MR images confirmed the clinical hypothesis. The emergence of such a severe organic personality disorder and cognitive disturbances as a psychiatric complication of an endoscopic third ventriculostomy has not, it seems, been previously reported elsewhere. Clinicians should take these possible complications into account when recommending this so-called minimally invasive neuroendoscopic procedure.
