LETTERS
Schizencephaly and
Borderline Personality
Disorder
To the Editor: Schizencephaly is
a kind of poroencephaly
characterized by gray-matter lined
clefts of the cerebral mantle. It is
caused by an abnormal neural mi-
gration that can be identified by
ultrasound after the 20th week of
gestation. Young maternal age is
a risk factor. Its prevalence has been
estimated as 1.54/100,000.1 There are
very few case reports in the literature
describing the psychiatric comorbid-
ity of schizencephaly.
Case Report
This is a 28-year-old man who
presented to the emergency depart-
ment complaining of depressive
symptoms and suicidal ideation,
with a plan to overdose. His urine
toxicology screen was positive for
cocaine. His CT scan of the head
showed a cleft by gray matter
extending from the margin of the
right posterior frontal lobe to the
margin of the lateral ventricle, con-
sistent with schizencephaly. Neuro-
logical exam was significant for
left-sided hemiparesis, with
E44 http://neuro.psychiatryonline.org
decreased strength and sensation. He
reported a childhood history of
ADHD and reading disorder.
The patient admitted to chronic
suicidal ideation and feelings of
emptiness. He had taken several
overdoses that led to psychiatric
inpatient admissions. He reported
severe mood swings that would last
for a few hours, on average. He had
started using marijuana at the age of
7 years and cocaine at the age of 15
years and had been in jail for 5 years
after being charged with drug
possession. He had been involved in
multiple fights and had a big scar
in his face after being stabbed by
another man. The patient had
multiple tattoos on his body with
extreme statements such as “love”
and “hate,” “life” and “death,” and
derogatory comments against
authorities. He had had several
girlfriends, but acknowledged that
he had not been able to establish
intimacy with any. He reported
hearing the voice of a man and
a woman intermittently saying
that he is not worth it. He
showed frantic efforts to avoid
abandonment; every time he was
offered discharge, he stated that he
was getting worse and stated on
repeated occasions that he would
commit suicide.
J Neuropsychiatry Clin Neurosci 25:2, Spring 2013
Discussion
The patient met DSM-IV criteria for
borderline personality disorder with
antisocial traits. This is the second
case in the literature of a patient with
borderline personality disorder and
schizencephaly.2 Frontal cortex dys-
function is thought to contribute to
the impulsivity features of borderline
personality disorder.3 This case fur-
ther supports the theory that frontal
lobe lesions may play a role in the
pathophysiology of cluster B person-
ality disorders.
Fernando Espi Forcen, M.D.
Dept. of Psychiatry and Behavioral
Neuroscience
University of Chicago
Chicago, Illinois
e-mail: ferespi@hotmail.com
References
1. Curry CJ, Lammer EJ, Nelson V, et al:
Schizencephaly: heterogeneous etiologies in
a population of 4 million California births.
Am J Med Genet A 2005; 137:181–189
2. da Rocha FF, Malloy-Diniz L, de Sousa KC,
et al: Borderline personality features possibly
related to cingulate and orbitofronta cortices
dysfunction due to schizencephaly. Clin
Neurol Neurosurg 2008; 110:396–399
3. Berlin HA, Rolls ET, Iversen SD: Borderline
personality disorder, impulsivity, and the
orbitofrontal cortex. Am J Psychiatry 2005;
162:2360–2373