The paper reviewed here is a case report published in 2009 in the open access journal BMC Psychiatry by Douzenis and colleagues and is titled ‘Porencephaly and Psychosis: A Case Report and Review of the Literature‘.
The first thing to say is that this is a brief case report. Case reports limit the conclusions that can be drawn as the observations are derived from a single case. That being said, they are invaluable in providing evidence about rare conditions or comorbidities, observations of effective therapeutic interventions and demonstrating clinical insights which otherwise could not be effectively communicated. When case reports in the literature are aggregated they can offer additional insights.
In this case report, the authors describe the occurrence of Porencephaly in association with psychosis. The term Porencephaly is used to describe a cavity in the brain which may result from a number of different causes. They describe the case of a 25 year old woman who presents to casualty with psychotic features including referential and paranoid delusions, blunted affect and thought blocking. The Positive and Negative Symptom Scale was completed as was an MMSE and WAIS. The WAIS full scale score was 64 with 69 on verbal and 63 on performance and her level of functioning would then be helpful in contextualising these results. The researchers have included images from the CT scan of the head, one of which is included below.
The frontal and temporal lobes are involved and the researchers draw on examples from the literature to suggest that the location of the lesions would be relevant to the psychosis. There is no doubt that the frontal and temporal lobes are involved in a variety of physiological functions and that pathology in these structures is also associated with a wide variety of clinical manifestations including psychosis. They are cautious in using high affinity D2 blockade in view of the structural pathology and opt for Olanzapine with good response.
I thought this was an interesting case study providing clear evidence of pathology and a plausible connection with the clinical manifestations. In discussions of this nature, I think it is always useful to have a model. In this case perhaps Professor Crow’s model (see here and here) offers useful insights and indeed it would be interesting to learn more about her language difficulties. The case study is a useful addition to the literature. An additional feature that may be useful in case studies would be a standardised list of diagnoses that have been explicitly excluded as this type of information could be used to structure case series.
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