DOI: 10.1080/13554790490894002 Neurocase, 10(6): 420–425, 2004 Copyright © Taylor & Francis Inc. 1355-4795/04/1006–420$16.00 Neurocase Organic and psychogenic factors leading to executive dysfunctions in a patient suffering from surgery of a colloid cyst of the Foramen of Monro Matthias Brand 1 , Elke Kalbe 2 , Lutz W. Kracht 2 , Ulrich Riebel 3 , Jürgen Münch 3 , Josef Kessler 2 and Hans J. Markowitsch 1 1 Department of Physiological Psychology, University of Bielefeld, Bielefeld, Germany 2 Max-Planck-Institute for Neurological Research, Cologne, Germany 3 Department of Psychosomatic Medicine, Brandenburg-Klinik, Bernau (by Berlin), Germany Abstract The authors report a 41-year-old female patient who had suffered from colloid cyst of the Foramen of Monro. After surgical intervention in which the cyst was completely removed, her hydrocephalus decreased to normal ventricle size measured by MRI. However, the patient became depressive and reported vast difficulties in everyday life decision-making. An examination twenty months after surgery indicated psychiatric symptoms and abnormalities in personality. Neuropsychological investigation revealed average to above average performance in anterograde memory, attention, information processing, and intelligence. In contrast, the patient was severely impaired in decision-making, complex executive functions, and social cognition. In 18 F-2-fluoro-2-deoxy-D-glucose ( 18 FDG-PET) hypometabolism in bilateral dorsolateral prefrontal cortex, cingulate cortex and left fusiform gyrus was observed. The authors conclude that in this case decision-making deficits and executive dysfunctions are influenced by both organic and psychogenic factors. Introduction Tumors in the third ventricle region and their surgical removal can cause cognitive dysfunctions since this region is comprised of structures and fibre connections strongly asso- ciated with memory and other cognitive functions. Such structures and tracts include the mammillary bodies, the mediodorsal thalamic nucleus and anterior thalamic nuclei, the fornix, and the mammillothalamic tract (Markowitsch, 1988). However, neuropsychological investigations of patients with tumor surgery in this region revealed controver- sial results. Irrespective of the methods of tumor removal, some patients demonstrated cognitive and mnestic impair- ments in anterograde memory, executive functions, and fine manual speed control (Friedman et al., 2003). In contrast, other studies revealed no or minor neuropsychological defi- cits after surgery (Radaideh et al., 2002; Villani et al., 1997; Winkler et al., 2000). It is also unclear whether neuropsychi- atric symptoms and disturbances in emotional processing can occur following tumor surgeries in this region (Villani et al., 1997). The structures and fibre connections around the third ventricle are strongly linked with the amygdaloid complex and the orbitofrontal cortex (Markowitsch, 1988), both dis- cussed as involved in decision-making and social cognition (e.g. Bechara, 2003). Thus, tumors and tumor removal affect- ing the third ventricle region might also cause emotional disturbances and psychiatric symptoms. Additionally, possi- ble functional brain correlates of neuropsychological impair- ments in the absence of structural brain damage after surgery in those patients remain unclear. The aims of the present case report are to describe a neu- ropsychological and neuropsychiatric profile of a patient after removal of a cyst of the Foramen of Monro (interventriculare foramen) who became depressive after surgery and reported cognitive decline, primarily in decision-making abilities. It is also aimed to measure and describe possible structural or functional correlates of cognitive and emotional changes after tumor removal in this patient. Case History A 41-year-old female right-handed patient (ZZ) who had suf- fered from a 1.5-year-old colloid cyst of the Foramen of Monro (foramen interventriculare) was examined. Before the examination ZZ was informed about the procedure of the study and gave written consent. Prior to the onset of disease, the patient worked as an edu- cationist. In her life history, no psychiatric or neurological signs were reported. Her childhood and adolescence were described as normal and no signs for a developmental disorder Corresponding author: Matthias Brand Department of Physiological Psychology University of Bielefeld P.O. Box 100131 D-33501 Bielefeld Germany Phone: ++49-521-1064488 Fax: ++49-521-1066049 Email: m.brand@uni-bielefeld.de