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Letters   |    
Psychiatric Disturbance and Mild Intellectual Disability in the Context of a Vascular Malformation (Capillary Telangiectasia) of the Posterior Hippocampus and Subiculum
Alexandra Economou, Ph.D.; Gloria X. Zhang, M.D., M.S.; Christos D. Katsetos, M.D., Ph.D., F.R.C.Path.
The Journal of Neuropsychiatry and Clinical Neurosciences 2013;25:E23-E24. doi:10.1176/appi.neuropsych.12060157
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Dept. of Psychology National and Kapodistrian University of Athens Athens, Greece
Dept. of Pathology and Laboratory Medicine Drexel University College of Medicine Philadelphia, PA
Depts. of Pediatrics, Pathology and Laboratory Medicine, and Neurology Drexel University College of Medicine St. Christopher’s Hospital for Children Philadelphia, PA

Correspondence: Alexandra Economou, Ph.D.; e-mail: aoikono@psych.uoa.gr

Copyright © 2013 American Psychiatric Association

Extract

To the Editor: We report a case of a vascular malformation involving the right posterior subiculum and contiguous hippocampus, which was discovered incidentally at autopsy in a 52-year-old woman with lifelong history of mental illness and mild intellectual disability who died as a result of cardiorespiratory arrest and acute global anoxic/ischemic encephalopathy. As per family, patient was born by forceps delivery, and her cognitive deficit was attributed to an intrapartum brain injury. Psychiatric disturbances included dependent personality disorder, depression, and obsessive-compulsive disorder. Before her death, the patient was on valproic acid/divalproex 250 mg bid, quetiapine 200 mg–300 mg once daily, and fluoxetine 20 mg. Her medical history was also significant for colitis (not further defined), hypercholesterolemia, and obesity. There was no history of seizures, attention-deficit hyperactivity disorder, cerebral palsy, or Prader-Willi syndrome.

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FIGURE 1. Coronal Section at the Level of the Pulvinar Thalamus

Figure shows a discrete and well-circumscribed vascular lesion (arrow) involving the right posterior subiculum and adjoining portion of the CA1 subfield of the hippocampus.

FIGURE 2. Sharply Delimited Vascular Malformation (arrows)

Vascular malformation involves the subiculum (sub) and a contiguous segment of the CA1 subfield of the hippocampus, characterized by variously dilated (ectatic) terminal vascular channels, with normal brain tissue in the intervening parenchyma, compatible with a capillary telangiectasia. Histological sections are stained with hematoxylin and eosin (Panels A and C) and Masson trichrome (panels B and D).

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