Porencephaly and Psychosis: A Rare Case of Neurological and Psychiatric Intersection

Porencephaly is an uncommon neurological condition characterized by cystic cavities or holes in the cerebral hemispheres of the brain filled with cerebrospinal fluid. There are two types of porencephaly: acquired porencephaly, also known as pseudo-porencephaly, and congenital porencephaly, also known as true porencephaly. Acquired porencephaly, also known as encephaloclastic porencephaly, typically results from late prenatal or perinatal vascular lesions caused by arterial ischemic stroke or venous thrombosis. Congenital porencephaly, or genetic porencephaly, arises from maldevelopment during early neuronal migration. Brain lesions associated with congenital porencephaly are thought to result from irregularities in cell migration during development and are often linked to additional brain deformities. Lesions resulting from degenerative disorders caused by vascular, viral, or traumatic events are classified under acquired porencephaly. Familial cases of porencephaly are believed to be caused by mutations in the COL4A1 gene, which lead to brain small-vessel disease with haemorrhage. Due to the variability in lesion size and location, porencephaly presents with a wide range of clinical symptoms. We report a case of a 41-year-old male who is diagnosed as a case of porencephaly with complaints of withdrawn behaviour, decreased interaction, suspiciousness, delusion of persecution and delusion of reference. These symptoms have started in the past two months. This case report contributes to the growing body of research suggesting a potential link between porencephaly and psychosis, despite the limited available data. Further investigation is required to validate this connection and explore the underlying mechanisms. Continued research into this potential association may help guide future psychosis diagnosis and treatment plans.