Third ventricular colloid cyst and chronic mania

To the Editor

Colloid cyst of the third ventricle may present with a variety of psychiatric symptoms. Chronic mania is defined as persistence of manic symptoms for more than 2 years without remission (Malhi et al., 2001). Here, we report a case of chronic mania in a patient with colloid cyst of the third ventricle, which has hitherto not been reported.

A 46-year-old male was seen at an inpatient facility for homeless persons ran by a non-profit organization in South India during regular weekly psychiatric service in 2016 with complaints of increased talkativeness, grandiose ideas and reduced sleep. There was no significant psychomotor agitation. He was brought by police from the street, and there was no contact address available to clarify past psychiatric history. When he was asked about his address and occupation, he said that he was an Australian resident working in film industry. There were no medical comorbidities. He was diagnosed provisionally with bipolar affective disorder, current episode manic with psychotic symptoms. He was treated with sodium valproate 1500 mg/day and olanzapine up to 20 mg/day. He reported improvements in biological functions. However, grandiose ideas and constant euphoria persisted. Considering absence of significant agitation and no significant problems with other inmates, he was maintained on the same dose. He started to have significant sedation and recurrent falls in early 2019. The dose of olanzapine was reduced, but he continued to fall. A computed tomography (CT) scan of the brain was done, and the result showed a well-defined round hyperdense lesion (colloid cyst) in third ventricle without any obstructive features.

Colloid cyst of the third ventricle has been reported to be associated with depression, delusion, hypersomnia, memory lapses, anxiety attacks, hallucinations and Korsakoff’s syndrome. To the best of our knowledge, there are only two published reports of manic symptoms in patients with colloid cyst of the third ventricle till date. Javed and Dutta reported the case of a 57-year-old male presenting initially with persecutory delusions, who later developed a hypomanic state. A CT brain revealed colloidal cyst of the anterior third ventricle without hydrocephalus, which was treated by decompression and marsupialisation, leading to complete resolution of symptoms (Javed and Dutta, 2014). Bhatia et al. (2013) reported another case of a 24-year-old female with recurrent mania in association with third ventricle colloid cyst, which remitted after surgical intervention. We report this case to add to the literature that colloid cyst of the third ventricle may rarely be associated with chronic mania.