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Posterior Fossa Sub-Arachnoid Cysts Observed in Patients with Bipolar Disorder: a Retrospective Cohort Study

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Abstract

Posterior fossa arachnoid cysts (PFACs) are rare congenital abnormalities observed in 0.3 to 1.7% of the population and are traditionally thought to be benign. While conducting a neuroimaging study investigating cerebellar structure in bipolar disorder, we observed a higher incidence of PFACs in bipolar patients (5 of 75; 6.6%) compared to the neuronormative control group (1 of 54; 1.8%). In this report, we detail the cases of the five patients with bipolar disorder who presented with PFACs. Additionally, we compare neuropsychiatric measures and cerebellar volumes of these patients to neuronormative controls and bipolar controls (those with bipolar disorder without neuroanatomical abnormalities). Our findings suggest that patients with bipolar disorder who also present with PFACs may have a milder symptom constellation relative to patients with bipolar disorder and no neuroanatomical abnormalities. Furthermore, our observations align with prior literature suggesting an association between PFACs and psychiatric symptoms that warrants further study. While acknowledging sample size limitations, our primary aim in the present work is to highlight a connection between PFACs and BD-associated symptoms and encourage further study of cerebellar abnormalities in psychiatry.

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Acknowledgements

We would like to thank Fatimah Albazron, Jennifer G. Richards, Leela Sathyaputri, and Laren Garrett for their work on participant recruitment and their excellent technical assistance. This research was supported in part through computational resources provided by The University of Iowa, Iowa City, Iowa, and the team at ITS—Research Services.

Funding

This work was supported by the following grants: NIH grant R01MH111578, S10OD025025 (MRI instrument fund), and The University of Iowa Bipolar Disorder Research program of Excellence funded by the Roy J. Carver Charitable Trust.

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Author notes

  1. Victόria A. Müller Ewald and Jessica R. Purnell contributed equally as first authors.

  2. Krystal L. Parker and Jess G. Fiedorowicz contributed equally as last/Senior authors.

Authors and Affiliations

  1. Department of Psychiatry, The University of Iowa, 195-207 Newton Road, Iowa City, IA, 52246, USA

    Victόria A. Müller Ewald, Jessica R. Purnell, John A. Wemmie, Vincent A. Magnotta, Aaron D. Boes & Krystal L. Parker

  2. Department of Neurology, The University of Iowa, Iowa City, IA, USA

    Joel E. Bruss

  3. Department of Epidemiology, The University of Iowa, Iowa City, IA, USA

    Ercole J. Barsotti & Kurayi G. Mahachi

  4. Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA

    Amro S. Aldine

  5. Department of Radiology, The University of Iowa, Iowa City, IA, USA

    Vincent A. Magnotta

  6. Department of Biomedical Engineering, The University of Iowa, Iowa City, IA, USA

    Vincent A. Magnotta

  7. Department of Pediatrics, The University of Iowa, Iowa City, IA, USA

    Aaron D. Boes

  8. Brain and Mind Institute, University of Ottawa, The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, ON, Canada

    Jess G. Fiedorowicz

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Contributions

VAME: research project—organization, execution; data analysis—execution, review and critique; manuscript—manuscript—writing manuscript drafts, review and critique; JRP: research project—organization, execution; data analysis—execution, review and critique; manuscript—writing manuscript drafts, review and critique; JEB: data analysis—execution, review and critique; EJB: data analysis—execution, review and critique; manuscript—review and critique; ASA: research project—conception, execution; KGM: data analysis—design, execution, review and critique; JAW: research project—conception, organization, execution; data analysis—review and critique; manuscript—review and critique; VAM: research project—organization; data analysis—design, execution, review and critique; manuscript—review and critique; ADB: research project—conception; data analysis—design, execution, review and critique; manuscript—review and critique; KLP: research project—conception, organization, execution; data analysis—design, review and critique; manuscript—review and critique; JGF: research project—conception, organization, execution; data analysis—design, review and critique; manuscript—writing manuscript drafts, review and critique.

Corresponding author

Correspondence to Krystal L. Parker.

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Ethics Approval

All participants provided written informed consent in accordance with the University of Iowa Human Subjects Review Board policies. All procedures performed in the present work were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its amendments or comparable ethical standards.

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The authors declare no competing interests.

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12311_2022_1408_MOESM1_ESM.png

Supplementary file1 Supplemental Fig. 1 Magnetic resonance images (MRI) of study participants who presented with posterior fossa arachnoid cysts, axial, and coronal views. a-e MRI images for bipolar patients, Mr. A, Mr. B, Mr. C, Ms. D and Ms. E, respectively. f MRI images for control participant, Mr. F. Cysts outlines in blue. (PNG 133 KB)

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Ewald, V.A.M., Purnell, J.R., Bruss, J.E. et al. Posterior Fossa Sub-Arachnoid Cysts Observed in Patients with Bipolar Disorder: a Retrospective Cohort Study. Cerebellum 22, 370–378 (2023). https://doi.org/10.1007/s12311-022-01408-1

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