Cerebellar pilocytic astrocytoma in a patient with autism spectrum disorder and psychotic symptoms: a case report.

A 16-year-old boy with autism developed hearing voices and false beliefs at age 13. Doctors found a brain tumor in his cerebellum (back part of brain). After surgeons removed the tumor, the psychotic symptoms completely disappeared without medication and haven't returned after 3 years. His autism traits stayed the same. This suggests brain tumors in certain areas might cause psychiatric symptoms in people with autism.

This case report describes a 16-year-old male with autism spectrum disorder who developed psychotic symptoms including auditory hallucinations and delusions at age 13. Brain imaging revealed a 3cm cerebellar pilocytic astrocytoma (brain tumor). Following surgical removal of the tumor, his psychotic symptoms completely resolved without antipsychotic medication and remained absent during 3-year follow-up, while his core autism characteristics persisted. This case suggests cerebellar pathology may contribute to psychotic symptoms and supports emerging theories about cerebellar involvement in higher-order functions including cognition, emotional regulation, and social behavior.

The findings highlight potential connections between cerebellar dysfunction and both psychotic symptoms and autism spectrum disorder.

Highlights importance of neuroimaging when psychotic symptoms emerge in individuals with autism. Suggests cerebellar evaluation should be considered in differential diagnosis. Supports potential for surgical intervention over pharmacological treatment in cases with identified cerebellar pathology.

Single case report limits generalizability. No control group or comparison cases. Cannot establish causation between cerebellar tumor and psychotic symptoms. Limited sample size prevents broader conclusions about cerebellar-autism-psychosis relationships.

Psychiatric symptoms, including psychotic manifestations such as hallucinations and delusions, are common in patients with brain tumors, typically associated with tumors in the frontal and temporal lobes. Psychotic symptoms are rarely linked to cerebellar tumors. However, recent evidence suggests that the cerebellum is involved in higher-order functions like cognition, emotional regulation, and social behavior. This report describes the case of a patient with autism spectrum disorder (ASD) who presented with a unique combination of a cerebellar tumor and psychotic symptoms, achieved complete remission of psychotic symptoms without antipsychotic treatment, and was followed up for three years.

A 16-year-old male with longstanding ASD presented with auditory hallucinations, delusional beliefs, and thought disorder. Since childhood, he displayed features such as poor eye contact, hypersensitivity to sounds, solitary play, restricted interests, and behavioral rigidity. At age 13, he began experiencing fluctuating psychotic symptoms, which were later diagnosed as schizophrenia-like psychotic features alongside his ASD. Brain magnetic resonance imaging (MRI) revealed a 3-cm cerebellar mass, which was identified as a pilocytic astrocytoma upon surgical resection.

Notably, the patient's psychotic symptoms completely resolved after surgery, without the use of antipsychotic medication, and have not recurred during a 3-year follow-up, while his core characteristics of ASD remained unchanged. This case suggests that cerebellar pathology may contribute to the development of psychotic symptoms, supporting the hypothesis that cerebellar dysfunction can lead to schizophrenia-like features. It also highlights the potential link between cerebellar dysfunction and ASD. Given the slow-growing nature of pilocytic astrocytomas, the case highlights the importance of considering cerebellar pathology in the differential diagnosis of psychosis, with implications for understanding disorders like ASD.