(PS4-99) Three Patients Presenting with Symptoms of Depersonalization and Derealization Following Colloid Cyst Resection

Background: Colloid cysts (CC) are rare, benign, slow-growing brain cysts that primarily occur in the anterior aspect of the third ventricle, at the junction of paired lateral ventricles. CCs sometimes grow to impede the flow of cerebrospinal fluid, resulting in obstructive hydrocephalus. The function of structures comprising the walls of the third ventricle, including the fornix, mammillary bodies, thalamus, and hypothalamus, may be disrupted by the cyst, hydrocephalus and/or mechanical manipulation during surgical intervention.     

Owing to the rarity of colloid cysts, the neurocognitive, psychiatric, and psychological sequelae of these cysts and their neurosurgical resection have been under-studied. Extant literature primarily describes associated deficits in memory, and less often, in attention. Psychiatric and psychological symptoms include emotional disturbance, anxiety, delusions, hallucinations, mania, depersonalization, depression and personality changes. Notably, improvements in the aforementioned symptoms are frequently documented following surgery.

Main

Objective: The current case study describes the clinical presentation and neuropsychological evaluation findings of three colloid cyst patients following successful endoscopic resection. Of particular relevance are the symptoms of depersonalization (DP) and derealization (DR) described by all three patients, as these symptoms are rarely documented, subjectively described, or formally assessed in the existing CC literature. Furthermore, clinical interviews conducted post-operatively revealed significant emotional distress related to DP and DR. Our first goal is therefore to provide a comprehensive description of patients’ psychological, psychiatric and neurocognitive presentation. Second, we provide suggestions for the evaluation of DP and DR symptoms in the CC population.

Methods: Patients presented for clinical interview and neuropsychological evaluation following  successful surgical CC resection. Self-report measures of depression and anxiety were also administered at this time.

Results:  Clinical interviews revealed strikingly similar descriptions of dissociative symptoms among three CC patients. Specifically, patients described feeling as though their surroundings were unreal or different, that previously familiar people and places felt unfamiliar, emotional detachment, and disturbances in their perception of time. Mood measures reveled increased levels of depression and anxiety. Neuropsychological evaluation results revealed normatively intact cognitive functioning, although some relative weaknesses were noted in each patient.

Conclusions: Comprehensive evaluation of CC patients includes assessment of psychological and psychiatric functioning, in addition to traditional neuropsychological evaluation. Symptoms of DP and DR may not only lead to emotional distress, but disrupt patients’ occupational and daily functioning, interpersonal relationships, and physical recovery. We propose the administration of self-report measures, such as the Cambridge Depersonalization Scale, and delineate pre- and post-operative administration intervals.