Psychiatric symptoms as leading symptoms in patients with cerebellar tumors

Background: Cerebellar tumors in childhood usually presents with ataxia, nystagmus or signs of raised intracranial pressure including vomiting. Only few reports exists in which psychiatric disorders are the main manifestation of cerebellar tumors.

Case histories: 2 young girls were admitted to our clinic with psychiatric symptoms for further work up and therapy. 5 days prior to admission the 13-year-old patient became confused and restless. She was not oriented to place, time and person and also had delusional thoughts. Neurological examination except for a bilateral strabismus convergence was normal. In particular, she had no cranial nerve deficit, truncal or gait ataxia.

The 17-year-old patient presented with symptoms starting 6 months ago suggestive of an anxiety disorder and schizophrenia. Her neurological examination revealed a mild left-sided dysmetria, but no ataxia or papilledema. At the time she was taking zyprexa and chlorprothixen.

Results: MRI studies of the brain showed a tumor of the cerebellar hemispheres in both patients without signs of raised intracranial pressure. Both tumors could be completely removed. The histopathological diagnosis was a pilozytic astrocytoma WHO I. Soon after surgery symptoms improved significantly. Patient 1 was orientated and had no delusional thoughts subsequently. The 17-year-old patient was able to stop her antipsychotic medications.

Conclusion: In selected cases cerebellar tumors can present with acute or chronic psychiatric symptoms. Therefore, in young patients with psychiatric disorders a cranial MRI should be included in the work up.