Cerebellar Pilocytic Astrocytoma with Autism and Psychosis: Case Study

Overview

This case study describes a 16-year-old male with cerebellar pilocytic astrocytoma who exhibited autism spectrum disorder (ASD) and schizophrenia-like psychotic symptoms. Remarkably, his psychotic symptoms resolved completely after tumor resection without antipsychotic treatment and did not recur over a 3-year follow-up, while ASD characteristics remained unchanged.

Background

Psychiatric symptoms are common in patients with brain tumors, with depression, anxiety, and psychosis frequently reported depending on tumor location. Tumors in the cerebral cortex, especially frontal and temporal lobes, are often associated with psychotic symptoms. Cerebellar tumors typically cause cognitive affective syndrome but are less commonly linked to psychosis. Emerging evidence suggests cerebellar dysfunction may be involved in neurodevelopmental disorders such as ASD. Pilocytic astrocytoma is a slow-growing CNS tumor often found in childhood, and its relationship with ASD and psychosis is not well understood.

Data Highlights

The patient was a 16-year-old male with a cerebellar tumor approximately 3 cm in diameter identified on MRI. Neuropsychological testing showed a Full-Scale IQ of 111 (WAIS-IV). EEG was normal without paroxysmal abnormalities. Psychotic symptoms resolved completely following surgical resection of the tumor without antipsychotic medication and remained absent over a 3-year follow-up period. ASD diagnosis was based on DSM-5 criteria from clinical interviews and developmental history.

Key Findings

• The patient exhibited early childhood signs consistent with ASD, including poor eye contact, hypersensitivity to sounds, social withdrawal, restricted interests, and insistence on routines.
• He developed schizophrenia-like psychotic symptoms (auditory hallucinations, paranoid delusions, thought disorder) during adolescence.
• Brain MRI revealed a 3 cm cerebellar pilocytic astrocytoma, a tumor not typically associated with psychosis.
• Psychotic symptoms resolved completely after tumor resection without antipsychotic treatment and did not recur over 3 years.
• ASD characteristics remained stable before and after tumor removal, suggesting distinct pathophysiological mechanisms.
• This case highlights a rare association of cerebellar tumor with reversible psychosis and coexisting ASD, underscoring the cerebellum's role in neurodevelopmental and psychiatric disorders.

Clinical Implications

Clinicians should consider brain imaging in patients presenting with new-onset psychotic symptoms, especially when accompanied by neurodevelopmental disorders such as ASD. Cerebellar tumors, though uncommon causes of psychosis, may produce reversible psychiatric symptoms that improve with surgical intervention. This case emphasizes the importance of multidisciplinary evaluation and tailored management without immediate reliance on antipsychotic medications in select cases.

Conclusion

This unique case of cerebellar pilocytic astrocytoma associated with ASD and reversible psychosis provides valuable insight into the cerebellum's involvement in psychiatric and neurodevelopmental disorders. Surgical resection can lead to complete resolution of psychotic symptoms without pharmacotherapy, highlighting the need for thorough neurological assessment in complex psychiatric presentations.

References

1. Van der Meer et al. 2020 -- Prevalence of depression and anxiety in glioma patients
2. Author Unknown 2019 -- Psychotic symptoms in brain tumor patients
3. Author Unknown 2018 -- Psychiatric manifestations of frontal lobe lesions
4. Author Unknown 2017 -- Temporal and parietal lobe tumor symptomatology
5. Author Unknown 2016 -- Cerebellar cognitive affective syndrome
6. Author Unknown 2015 -- Cerebellar dysfunction and neurodevelopmental disorders
7. Author Unknown 2014 -- Pilocytic astrocytoma and autism spectrum disorder