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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0867

The overlooked connection: a case report on psychological symptoms in Dandy-Walker malformation

THE OVERLOOKED CONNECTION: A CASE REPORT ON PSYCHOLOGICAL MANIFESTATIONS IN DANDY-WALKER MALFORMATION

Dandy-Walker malformation can present not only with neurological findings but also with psychiatric and behavioral disturbances, such as aggression, impaired self-care, and cognitive difficulties.

This case report aims to draw attention to the psychiatric and behavioral manifestations of Dandy-Walker syndrome (DWS), a rare congenital brain malformation. The patient presented is an 18-year-old male; despite a history of full-term, uncomplicated birth, he reportedly had delayed developmental milestones, poor academic performance, school dropout in the fourth grade, and an inability to maintain employment due to cognitive limitations. His behavioral history includes aggressive and destructive outbursts of anger since the age of 15, frequent fighting, running away from home, impaired self-care, and social withdrawal; his presenting complaints were frequent falls and headaches for 1 month, impaired self-care for 1 year, and aggression for 3 years. Examination revealed childlike speech, impaired abstract thinking, and difficulties with attention and concentration, while the neurological examination was normal. Intelligence testing indicated mild to moderate intellectual disability, and brain CT showed a posterior fossa cyst, vermian hypoplasia, and an enlarged fourth ventricle, consistent with classic Dandy-Walker malformation. Olanzapine was initiated at 5–10 mg/day, with a reported improvement of approximately 50% in aggression; psychiatric follow-up was continued, and a neurology consultation was requested. The discussion notes that DWS occurs in approximately 1 in 25,000 to 30,000 births, that psychiatric symptoms such as aggression, psychosis, and cognitive decline are underreported in adolescents, that the literature suggests a possible link between cerebellar dysfunction and the cortico-thalamo-cerebellar circuits implicated in psychosis, and that the response to antipsychotics may vary. The clinical message is that new-onset aggression, deterioration in self-care, or social withdrawal in adolescents with congenital neurodevelopmental malformations warrants psychiatric assessment alongside neurological evaluation; early recognition of psychiatric symptoms, multidisciplinary care involving psychiatry, neurology, and pediatrics, and family psychoeducation are essential to long-term follow-up.

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