{"paper_id":"2d27e8bc-b4a8-4c92-871e-08a5a7cc71fe","body_text":"Cerebellar Pilocytic Astrocytoma in a Patient with Autism Spectrum Traits and Psychotic Symptoms: A Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Cerebellar Pilocytic Astrocytoma in a Patient with Autism Spectrum Traits and Psychotic Symptoms: A Case Report Kanji Itami, Keitaro Kimoto, Yuki Takahashi, Yuichi Onishi, Katsunaka Mikami, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7712199/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 25 Dec, 2025 Read the published version in BMC Psychiatry → Version 1 posted 12 You are reading this latest preprint version Abstract Background 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 case is noteworthy due to its unique combination of a cerebellar tumor and psychotic symptoms in a patient with autism spectrum disorder (ASD) traits. Case presentation: A 16-year-old male with longstanding ASD traits 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 traits. 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 ASD traits remain unchanged. Conclusions The 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 traits. Given the slow-growing nature of pilocytic astrocytomas, this case highlights the importance of considering cerebellar pathology in the differential diagnosis of psychosis, with implications for understanding disorders like ASD. Cerebellar Pilocytic Astrocytoma Autism Spectrum Disorder Psychosis Schizophrenia Brain Tumor Hallucination Figures Figure 1 Figure 2 I. Background Psychiatric symptoms are common in patients with brain tumors. Keschner et al. found that 78% of 530 patients with brain tumors exhibited psychiatric symptoms [ 1 ]. Among these, psychotic symptoms like hallucinations and delusions occur in approximately 22% of patients, most often in those with tumors affecting the cerebral cortex, particularly the frontal and temporal lobes [ 2 ]. The parietal and occipital lobes follow in frequency, while cerebellar tumors are least likely to cause psychotic symptoms. Recent studies suggest a link between cerebellar dysfunction and autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) [ 3 ]. Previous case reports have described ASD co-occurring with cerebellar damage, and a hypothesis has been proposed that pilocytic astrocytoma, a slow-growing central nervous system (CNS) tumor, typically found in childhood, may influence the development of ASD traits in early childhood [ 4 ]. Here, we report the case of a patient with cerebellar pilocytic astrocytoma who exhibited both ASD traits and psychotic symptoms. II. Case Presentation Case A 16-year-old male high school student Chief Complaint Hearing voices Developmental History : The patient was born full-term via normal vaginal delivery with normal birth weight. There were no delays in motor or language development. Since early childhood, he exhibited poor eye contact and hypersensitivity to certain sounds. He did not show interest in other children and preferred solitary play. While playing with toy trains, he was unable to stop midway, and when taken outside to see real trains, he refused to return home, showing difficulty in transitioning. He exhibited strong fixations, such as insisting on following specific self-imposed rules and always taking the same route. Even after starting elementary school, he continued to prefer solitary play and often had temper tantrums when things did not go as he wished. After graduating from elementary school, he took a junior high school entrance exam and began boarding at an integrated junior and senior high school. Present Illness : In the first year of junior high school (year X-4), he began experiencing auditory hallucinations, such as hearing voices talking to him or giving commands. He did not consult anyone about these symptoms and tried to cope alone. The symptoms were intermittent, disappeared at times. During his third year of junior high school (year X-1), the hallucinations temporarily subsided, but they returned intermittently. In his first year of high school (year X, month Y), he frequently visited the school infirmary, complaining of feeling unwell. After disclosing his auditory hallucinations and suicidal thoughts to the school nurse, he was referred to our hospital and visited for the first time on year X, month Y, day Z. Past Medical History : Appendicitis at age 16. Family History and Home Environment : The patient is an only child and lives with both parents. His father has a history of depression. Psychiatric Findings : The patient was alert and oriented, with no disturbances in consciousness or memory. His academic performance was excellent, and no intellectual disabilities were noted. He reported experiencing auditory hallucinations, saying, \"Sometimes I hear someone calling out to me.\" He also exhibited paranoid delusions, such as \"Someone is giving off signs that they want to kill me.\" Thought disorder was evident in messages he sent to friends, such as \"The immortal sweet roll. I was floating in the air. Next week I will go to Chen Guanyu.\" There were no signs of disturbances in self-identity. Since early childhood, he showed persistent qualitative impairments in reciprocal social interaction, communication, and restricted interests, with a tendency toward rigidity, indicating impaired imaginative function. He lacked insight into his condition, stating, \"I'm not ill, and I'm not having any problems.\" No neurological abnormalities were observed. Laboratory and Imaging Findings : Wechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV): Full-Scale Intelligence Quotient (IQ) 111; Verbal Comprehension 113; Perceptual Reasoning 107; Working Memory 119; Processing Speed 93 Electroencephalogram (EEG): Background rhythm consisted of 10 Hz alpha waves. No paroxysmal abnormalities were observed. Brain magnetic resonance imaging (MRI): A cerebellar tumor approximately 3 cm in diameter was identified (Fig. 1 ). Course of Treatment : No neurological abnormalities were observed. Based on the patient’s developmental history and current psychiatric symptoms, ASD and schizophrenia were considered as differential diagnoses. However, a brain MRI revealed a cerebellar tumor approximately 3 cm in diameter, prompting the attending psychiatrist to refer the patient to our department for neurosurgery. In month Y + 2 of year X, a surgical resection of the tumor was performed (Fig. 2 ). Histopathological examination confirmed a diagnosis of pilocytic astrocytoma . Following resection, the patient’s psychotic symptoms completely resolved and have not recurred for over three years. He is currently enjoying university life. Notably, no psychiatric medications, including antipsychotics, were administered at any point during the clinical course. III. Discussion and Conclusions We report a case of pilocytic astrocytoma of the cerebellum in a patient with ASD who presented with psychotic symptoms. A striking feature of this case was that although the patient initially sought psychiatric care for psychosis, further investigation revealed both a cerebellar tumor and long-standing ASD characteristics. The psychotic symptoms resolved completely following surgical resection of the tumor, without the need for psychotropic medications. The rapid resolution of psychotic symptoms post-resection, with no recurrence over three years, suggests that the cerebellar pilocytic astrocytoma may have been the underlying cause of the psychotic symptoms. Pilocytic astrocytoma is the most common CNS tumor in children, accounting for 15–25% of all pediatric CNS tumors and 25–35% of posterior fossa tumors. Its incidence peaks between ages of 6 and 8, with no significant sex differences. Classified as a World Health Organization (WHO) Grade I benign tumor, surgical resection is considered the standard first-line treatment [ 5 ]. Psychosis associated with pilocytic astrocytoma is rare, and most reports involve peduncular hallucinations. For example, some cases describe cerebellar tumors compressing the brainstem, including the midbrain, leading to peduncular hallucinations [ 6 ], while others report hallucinations persisting after midbrain tumors remained stable post-radiotherapy [ 7 ]. In contrast, the psychotic features in our case—paranoid delusions, dialogic auditory hallucinations, and thought disorder —were more aligned with schizophrenia, not peduncular hallucinations. Cerebellar abnormalities have been linked to schizophrenia-like psychotic symptoms, including hallucinations and delusions, through disruptions in the cortico-cerebellar-thalamic-cortical circuit (CCTCC), which is involved in cognitive dysfunction in schizophrenia [ 8 ]. Auditory verbal hallucinations (AVH) have also been associated with reduced gray matter volume (GMV) in specific cerebellar regions [ 9 ] and functional connectivity abnormalities involving the cerebellum [ 10 ]. In addition, cerebellar lesions, including those caused by strokes [ 11 ] or tumors [ 12 ], are associated with the onset of delusional thinking [ 12 , 13 ]. In this case, it is plausible that the mass effect of the cerebellar pilocytic astrocytoma contributed to the development of schizophrenia-like psychotic symptoms. The psychiatric consultation triggered by the onset of psychosis also led to the diagnosis of ASD. It is known that individuals with ASD may transiently exhibit psychotic-like symptoms [ 13 ]. Although ASD traits persisted after tumor resection, the rapid disappearance of psychotic symptoms suggests that psychosis was unlikely to be solely attributable to ASD. Previous reports have described comorbid ASD and cerebellar pilocytic astrocytoma [ 4 ]. Given the tumor’s slow-growing nature and frequent onset in early childhood, a congenital origin is sometimes considered, with some proposing a possible link between the tumor and ASD traits. Recent studies have also indicated associations between cerebellar dysfunction and both ASD and ADHD. The cerebellum, once primarily linked to motor coordination, is now understood to play a role in language, communication, reciprocal social behavior, and context-appropriate behavioral modulation [ 15 ]. Therefore, cerebellar dysfunction may contribute to the development of ASD-like traits. In this case, no clear changes in ASD characteristics were observed before or after tumor resection. However, considering the early onset of ASD traits and the slow-growing nature of pilocytic astrocytomas, which typically arise in childhood, it is plausible, although not conclusively demonstrated, that the tumor may have influenced the development of ASD traits. Abbreviations ASD Autism Spectrum Disorder ADHD Attention-Deficit/Hyperactivity Disorder CNS Central Nervous System MRI Magnetic Resonance Imaging WAIS IV-Wechsler Adult Intelligence Scale-Fourth Edition EEG Electroencephalogram IQ Intelligence Quotient WHO World Health Organization GMV Gray Matter Volume CCTCC Cortico-Cerebellar-Thalamic-Cortical Circuit AVH Auditory Verbal Hallucinations Declarations Ethics declaration: Not applicable. Consent for publication: Written informed consent was obtained from the patients and their families for this publication. Availability of data and materials: Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study. Competing interests: The authors declare that they have no competing interests. Funding: The authors declare that they received no financial support for this work. Authors' contributions: KI served as the attending physician. KK, YT, YO, KM, and KY were members of the treatment team and acted as supervisors. All authors contributed to patient care, discussed the clinical findings, and reviewed and approved the final manuscript. Acknowledgements: We sincerely thank the patients and their families for their cooperation in this study. References Keschner M, Bender MB, Strauss I. Mental symptoms associated with brain tumor: a study of 530 verified cases. JAMA. 1938;110:714–8. 10.1001/jama.1938.02790100012004] . Madhusoodanan S, Ting MB, Farah T, Ugur U. Psychiatric aspects of brain tumors. A review. World J Psychiatr. 2015;5(3):273 – 85 [PMID: 26425442 10.5498/wjp.v5.i3.273] Yeganeh-Doost P, Gruber O, Falkai P, Schmitt A. The role of the cerebellum in schizophrenia: from cognition to molecular pathways. Clinics. 2011;66(S1):71–7. Adachi K, Murai Y, Teramoto A. Infantile cerebellar pilocytic astrocytoma with autism spectrum disorder. J Nippon Med Sch. 2012;79(3):228–31. 10.1272/jnms.79.228] . Ruella M, Giovannini S, Chiusa CP, Zabala JP, Argañaraz R, Mantese B. Cerebellar pilocytic astrocytoma. Retrospective cohort study assessing postoperative functional outcome, cerebellar mutism and hydrocephalus. World Neurosurg. 2023;1–9. 10.1016/j.wnsx.2023.100180] . Navi SS, Ramdial PK. Transient peduncular hallucinations secondary to brain stem compression by a cerebellar pilocytic astrocytoma. Br J Neurosurg. 1998;12(6):579–81. [DOI: 10.1080/02688699844484]. Andrews JP, Taylor J, Saunders D, Qayyum Z. Peduncular psychosis. BMJ Case Rep. 2016;2016:bcr2016216165. [DOI: 10.1136/bcr-2016-216165]. Andreasen NC, O'Leary DS, Cizadlo T, Arndt S, Rezai K, Ponto LL, et al. Schizophrenia and cognitive dysmetria: a positron-emission tomography study of dysfunctional prefrontal-thalamic-cerebellar circuitry. Proc Natl Acad Sci U S A. 1996;93(18):9985–90. 10.1073/pnas.93.18.9985] . Cierpka M, Wolf ND, Kubera KM, Schmitgen MM, Vasic N, Frasch K, et al. Cerebellar Contributions to Persistent Auditory Verbal Hallucinations in Patients with Schizophrenia. Cerebellum. 2017;16(5–6). 10.1007/s12311-017-0874-5] . 964 – 72 [DOI:. Itahashi T, Mimura M, Hasegawa S, Tani M, Kato N, Hashimoto RI. Aberrant cerebellar-default-mode functional connectivity underlying auditory verbal hallucinations in schizophrenia revealed by multi-voxel pattern analysis of resting-state functional connectivity MRI data. Schizophr Res. 2018;197:607–8. 10.1016/j.schres.2018.02.013] . Neufeld N, Gallagher D, Aviv R, Feinstein A. Remote Cerebellar Stroke Associated With Delusions and Disorganization. J Neuropsychiatry Clin Neurosci. 2016;8(4):335–7. 10.1176/appi.neuropsych.15110398] . Nkire N, Barry H, Russell H. First episode psychosis and an underlying cerebellar tumour. Ir J Psychol Med. 2011;28(4):229–31. [DOI: 10.1017/S0790966700011733]. Sandyk R. Psychotic behavior associated with cerebellar pathology. Int J Neurosci. 1993;71(1–4):1–7. [DOI: 10.3109/00207459309000586]. Vaquerizo-Serrano J, Salazar de Pablo G, Singh J, Santosh P. Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis. J Autism Dev Disord. 2022;52:1568–86. 10.1007/s10803-021-05046-0] . Yeruva RR, Shang Y, Schoenbachler B, Nuss S, El-Mallakh RS. Anatomical association between schizophrenia and cerebellum. Innov Clin Neurosci. 2021;18(7–9):47–9. Additional Declarations Competing interest reported. Kanji Itami declares no competing interests. Keitaro Kimoto has received research grants from Otsuka Pharmaceutical Co., Ltd. and Shionogi & Co., Ltd., and honoraria from Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Viatris Inc. Yuki Takahashi has received research grants from Shionogi & Co., Ltd. Yuichi Onishi has received research grants and honoraria from Takeda Pharmaceutical Co., Ltd. Katsunaka Mikami has received financial support from Shionogi & Co., Ltd.; honoraria from Shionogi & Co., Ltd., Sumitomo Pharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Otsuka Pharmaceutical Co., Ltd.; travel and accommodation expenses from Otsuka Pharmaceutical Co., Ltd.; and consulting fees from Shionogi & Co., Ltd., EA Pharma Co., Ltd., Sumitomo Pharma Co., Ltd., and Otsuka Pharmaceutical Co., Ltd. Kenji Yamamoto has received grants and personal fees from Eisai Co., Ltd., Otsuka Pharmaceutical Co., Ltd., and Shionogi & Co., Ltd.; personal fees from Meiji Seika Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Merck Sharp & Dohme, Viatris Inc., Takeda Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Lundbeck Japan K.K., Daiichi Sankyo Co., Ltd., and OCTAWELL Co., Ltd.; and research support from JSPS KAKENHI (Grant Number 22K07588), outside the submitted work. Cite Share Download PDF Status: Published Journal Publication published 25 Dec, 2025 Read the published version in BMC Psychiatry → Version 1 posted Editorial decision: Revision requested 19 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviewers agreed at journal 19 Oct, 2025 Reviews received at journal 18 Oct, 2025 Reviewers agreed at journal 15 Oct, 2025 Reviews received at journal 14 Oct, 2025 Reviewers agreed at journal 14 Oct, 2025 Reviewers agreed at journal 06 Oct, 2025 Reviewers invited by journal 06 Oct, 2025 Editor assigned by journal 03 Oct, 2025 Submission checks completed at journal 03 Oct, 2025 First submitted to journal 25 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-7712199\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Case Report\",\"associatedPublications\":[],\"authors\":[{\"id\":530837764,\"identity\":\"28d97e40-4480-4e85-8e2a-3ca20b88f0df\",\"order_by\":0,\"name\":\"Kanji 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16:08:08\",\"extension\":\"xml\",\"order_by\":19,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":46173,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"81c6668c7e6a4bf085522693e77cd0251structuring.xml\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7712199/v1/f7d15f2c3621ba53fcd82bdb.xml\"},{\"id\":93796194,\"identity\":\"a01b2b73-6579-465e-a555-c24581432190\",\"added_by\":\"auto\",\"created_at\":\"2025-10-17 15:52:08\",\"extension\":\"html\",\"order_by\":20,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"acdc-reference\",\"size\":54435,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"earlyproof.html\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7712199/v1/ffcea86f1564435eda109832.html\"},{\"id\":93796175,\"identity\":\"ec9e1ebd-a747-4a18-ba15-4042f2ff4ed2\",\"added_by\":\"auto\",\"created_at\":\"2025-10-17 15:52:08\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":182775,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eT1- and T2-weighted MRI images\\u003c/p\\u003e\\n\\u003cp\\u003eT1- and T2-weighted brain MRI images show a well-circumscribed mass, approximately 3 cm in size, located in the cerebellar vermis. No other remarkable abnormalities were observed in the brain parenchyma or sulci.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7712199/v1/d7bab3ab73b98fc7f1edb656.png\"},{\"id\":93796176,\"identity\":\"ad832ab6-aeae-4776-a300-7f0b43689d54\",\"added_by\":\"auto\",\"created_at\":\"2025-10-17 15:52:08\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":198416,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePostoperative T1- and T2-weighted MRI images\\u003c/p\\u003e\\n\\u003cp\\u003ePostoperative T1- and T2-weighted brain MRI confirm the resection of the cerebellar vermis mass.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7712199/v1/451cd6d28c3d2c63606f0a64.png\"},{\"id\":99173047,\"identity\":\"850c1e1a-9d47-4daa-a48d-42834767ec8e\",\"added_by\":\"auto\",\"created_at\":\"2025-12-29 16:12:29\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":911484,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-7712199/v1/2c97af54-218f-448f-b9fb-7d8d561abf68.pdf\"}],\"financialInterests\":\"Competing interest reported. Kanji Itami declares no competing interests.\\nKeitaro Kimoto has received research grants from Otsuka Pharmaceutical Co., Ltd. and Shionogi \\u0026 Co., Ltd., and honoraria from Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Viatris Inc.\\nYuki Takahashi has received research grants from Shionogi \\u0026 Co., Ltd.\\nYuichi Onishi has received research grants and honoraria from Takeda Pharmaceutical Co., Ltd.\\nKatsunaka Mikami has received financial support from Shionogi \\u0026 Co., Ltd.; honoraria from Shionogi \\u0026 Co., Ltd., Sumitomo Pharma Co., Ltd., Takeda Pharmaceutical Co., Ltd., and Otsuka Pharmaceutical Co., Ltd.; travel and accommodation expenses from Otsuka Pharmaceutical Co., Ltd.; and consulting fees from Shionogi \\u0026 Co., Ltd., EA Pharma Co., Ltd., Sumitomo Pharma Co., Ltd., and Otsuka Pharmaceutical Co., Ltd.\\nKenji Yamamoto has received grants and personal fees from Eisai Co., Ltd., Otsuka Pharmaceutical Co., Ltd., and Shionogi \\u0026 Co., Ltd.; personal fees from Meiji Seika Pharma Co., Ltd., Sumitomo Dainippon Pharma Co., Ltd., Merck Sharp \\u0026 Dohme, Viatris Inc., Takeda Pharmaceutical Co., Ltd., Janssen Pharmaceutical K.K., Lundbeck Japan K.K., Daiichi Sankyo Co., Ltd., and OCTAWELL Co., Ltd.; and research support from JSPS KAKENHI (Grant Number 22K07588), outside the submitted work.\",\"formattedTitle\":\"Cerebellar Pilocytic Astrocytoma in a Patient with Autism Spectrum Traits and Psychotic Symptoms: A Case Report\",\"fulltext\":[{\"header\":\"I. Background\",\"content\":\"\\u003cp\\u003ePsychiatric symptoms are common in patients with brain tumors. Keschner et al. found that 78% of 530 patients with brain tumors exhibited psychiatric symptoms [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Among these, psychotic symptoms like hallucinations and delusions occur in approximately 22% of patients, most often in those with tumors affecting the cerebral cortex, particularly the frontal and temporal lobes [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The parietal and occipital lobes follow in frequency, while cerebellar tumors are least likely to cause psychotic symptoms.\\u003c/p\\u003e\\u003cp\\u003eRecent studies suggest a link between cerebellar dysfunction and autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Previous case reports have described ASD co-occurring with cerebellar damage, and a hypothesis has been proposed that pilocytic astrocytoma, a slow-growing central nervous system (CNS) tumor, typically found in childhood, may influence the development of ASD traits in early childhood [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eHere, we report the case of a patient with cerebellar pilocytic astrocytoma who exhibited both ASD traits and psychotic symptoms.\\u003c/p\\u003e\"},{\"header\":\"II. Case Presentation\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eCase\\u003c/strong\\u003e\\u003cp\\u003eA 16-year-old male high school student\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cstrong\\u003eChief Complaint\\u003c/strong\\u003e\\u003cp\\u003eHearing voices\\u003c/p\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eDevelopmental History\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eThe patient was born full-term via normal vaginal delivery with normal birth weight. There were no delays in motor or language development. Since early childhood, he exhibited poor eye contact and hypersensitivity to certain sounds. He did not show interest in other children and preferred solitary play. While playing with toy trains, he was unable to stop midway, and when taken outside to see real trains, he refused to return home, showing difficulty in transitioning. He exhibited strong fixations, such as insisting on following specific self-imposed rules and always taking the same route.\\u003c/p\\u003e\\u003cp\\u003eEven after starting elementary school, he continued to prefer solitary play and often had temper tantrums when things did not go as he wished. After graduating from elementary school, he took a junior high school entrance exam and began boarding at an integrated junior and senior high school.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePresent Illness\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eIn the first year of junior high school (year X-4), he began experiencing auditory hallucinations, such as hearing voices talking to him or giving commands. He did not consult anyone about these symptoms and tried to cope alone. The symptoms were intermittent, disappeared at times. During his third year of junior high school (year X-1), the hallucinations temporarily subsided, but they returned intermittently. In his first year of high school (year X, month Y), he frequently visited the school infirmary, complaining of feeling unwell. After disclosing his auditory hallucinations and suicidal thoughts to the school nurse, he was referred to our hospital and visited for the first time on year X, month Y, day Z.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePast Medical History\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eAppendicitis at age 16.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eFamily History and Home Environment\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eThe patient is an only child and lives with both parents. His father has a history of depression.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003ePsychiatric Findings\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eThe patient was alert and oriented, with no disturbances in consciousness or memory. His academic performance was excellent, and no intellectual disabilities were noted. He reported experiencing auditory hallucinations, saying, \\\"Sometimes I hear someone calling out to me.\\\" He also exhibited paranoid delusions, such as \\\"Someone is giving off signs that they want to kill me.\\\" Thought disorder was evident in messages he sent to friends, such as \\\"The immortal sweet roll. I was floating in the air. Next week I will go to Chen Guanyu.\\\" There were no signs of disturbances in self-identity.\\u003c/p\\u003e\\u003cp\\u003eSince early childhood, he showed persistent qualitative impairments in reciprocal social interaction, communication, and restricted interests, with a tendency toward rigidity, indicating impaired imaginative function. He lacked insight into his condition, stating, \\\"I'm not ill, and I'm not having any problems.\\\" No neurological abnormalities were observed.\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eLaboratory and Imaging Findings\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003e\\u003col\\u003e\\u003cspan\\u003e\\u003cli\\u003e\\u003cp\\u003eWechsler Adult Intelligence Scale - Fourth Edition (WAIS-IV): Full-Scale Intelligence Quotient (IQ) 111; Verbal Comprehension 113; Perceptual Reasoning 107; Working Memory 119; Processing Speed 93\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/span\\u003e\\u003cspan\\u003e\\u003cli\\u003e\\u003cp\\u003eElectroencephalogram (EEG): Background rhythm consisted of 10 Hz alpha waves. No paroxysmal abnormalities were observed.\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/span\\u003e\\u003cspan\\u003e\\u003cli\\u003e\\u003cp\\u003eBrain magnetic resonance imaging (MRI): A cerebellar tumor approximately 3 cm in diameter was identified (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e).\\u003c/p\\u003e\\u003c/li\\u003e\\u003c/span\\u003e\\u003c/ol\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003e\\u003cb\\u003eCourse of Treatment\\u003c/b\\u003e:\\u003c/p\\u003e\\u003cp\\u003eNo neurological abnormalities were observed. Based on the patient\\u0026rsquo;s developmental history and current psychiatric symptoms, ASD and schizophrenia were considered as differential diagnoses. However, a brain MRI revealed a cerebellar tumor approximately 3 cm in diameter, prompting the attending psychiatrist to refer the patient to our department for neurosurgery. In month Y\\u0026thinsp;+\\u0026thinsp;2 of year X, a surgical resection of the tumor was performed (Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e\\u003cp\\u003e\\u003c/p\\u003e\\u003cp\\u003eHistopathological examination confirmed a diagnosis of \\u003cb\\u003epilocytic astrocytoma\\u003c/b\\u003e. Following resection, the patient\\u0026rsquo;s psychotic symptoms completely resolved and have not recurred for over three years. He is currently enjoying university life. Notably, no psychiatric medications, including antipsychotics, were administered at any point during the clinical course.\\u003c/p\\u003e\"},{\"header\":\"III. Discussion and Conclusions\",\"content\":\"\\u003cp\\u003eWe report a case of pilocytic astrocytoma of the cerebellum in a patient with ASD who presented with psychotic symptoms. A striking feature of this case was that although the patient initially sought psychiatric care for psychosis, further investigation revealed both a cerebellar tumor and long-standing ASD characteristics. The psychotic symptoms resolved completely following surgical resection of the tumor, without the need for psychotropic medications.\\u003c/p\\u003e\\u003cp\\u003eThe rapid resolution of psychotic symptoms post-resection, with no recurrence over three years, suggests that the cerebellar pilocytic astrocytoma may have been the underlying cause of the psychotic symptoms.\\u003c/p\\u003e\\u003cp\\u003ePilocytic astrocytoma is the most common CNS tumor in children, accounting for 15\\u0026ndash;25% of all pediatric CNS tumors and 25\\u0026ndash;35% of posterior fossa tumors. Its incidence peaks between ages of 6 and 8, with no significant sex differences. Classified as a World Health Organization (WHO) Grade I benign tumor, surgical resection is considered the standard first-line treatment [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003ePsychosis associated with pilocytic astrocytoma is rare, and most reports involve peduncular hallucinations. For example, some cases describe cerebellar tumors compressing the brainstem, including the midbrain, leading to peduncular hallucinations [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e], while others report hallucinations persisting after midbrain tumors remained stable post-radiotherapy [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn contrast, the psychotic features in our case\\u0026mdash;paranoid delusions, dialogic auditory hallucinations, and thought disorder \\u0026mdash;were more aligned with schizophrenia, not peduncular hallucinations.\\u003c/p\\u003e\\u003cp\\u003eCerebellar abnormalities have been linked to schizophrenia-like psychotic symptoms, including hallucinations and delusions, through disruptions in the cortico-cerebellar-thalamic-cortical circuit (CCTCC), which is involved in cognitive dysfunction in schizophrenia [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. Auditory verbal hallucinations (AVH) have also been associated with reduced gray matter volume (GMV) in specific cerebellar regions [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e] and functional connectivity abnormalities involving the cerebellum [\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn addition, cerebellar lesions, including those caused by strokes [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e] or tumors [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e], are associated with the onset of delusional thinking [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].\\u003c/p\\u003e\\u003cp\\u003eIn this case, it is plausible that the mass effect of the cerebellar pilocytic astrocytoma contributed to the development of schizophrenia-like psychotic symptoms.\\u003c/p\\u003e\\u003cp\\u003eThe psychiatric consultation triggered by the onset of psychosis also led to the diagnosis of ASD. It is known that individuals with ASD may transiently exhibit psychotic-like symptoms [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Although ASD traits persisted after tumor resection, the rapid disappearance of psychotic symptoms suggests that psychosis was unlikely to be solely attributable to ASD.\\u003c/p\\u003e\\u003cp\\u003ePrevious reports have described comorbid ASD and cerebellar pilocytic astrocytoma [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Given the tumor\\u0026rsquo;s slow-growing nature and frequent onset in early childhood, a congenital origin is sometimes considered, with some proposing a possible link between the tumor and ASD traits.\\u003c/p\\u003e\\u003cp\\u003eRecent studies have also indicated associations between cerebellar dysfunction and both ASD and ADHD. The cerebellum, once primarily linked to motor coordination, is now understood to play a role in language, communication, reciprocal social behavior, and context-appropriate behavioral modulation [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. Therefore, cerebellar dysfunction may contribute to the development of ASD-like traits.\\u003c/p\\u003e\\u003cp\\u003eIn this case, no clear changes in ASD characteristics were observed before or after tumor resection. However, considering the early onset of ASD traits and the slow-growing nature of pilocytic astrocytomas, which typically arise in childhood, it is plausible, although not conclusively demonstrated, that the tumor may have influenced the development of ASD traits.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eASD\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAutism Spectrum Disorder\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eADHD\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAttention-Deficit/Hyperactivity Disorder\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eCNS\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eCentral Nervous System\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eMRI\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eMagnetic Resonance Imaging\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eWAIS\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eIV-Wechsler Adult Intelligence Scale-Fourth Edition\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eEEG\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eElectroencephalogram\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eIQ\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eIntelligence Quotient\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eWHO\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eWorld Health Organization\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eGMV\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eGray Matter Volume\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eCCTCC\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eCortico-Cerebellar-Thalamic-Cortical Circuit\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e\\u003cdiv class=\\\"Term\\\"\\u003eAVH\\u003c/div\\u003e\\u003cdiv class=\\\"Description\\\"\\u003e\\u003cp\\u003eAuditory Verbal Hallucinations\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics declaration:\\u0026nbsp;\\u003c/strong\\u003eNot applicable.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication:\\u0026nbsp;\\u003c/strong\\u003eWritten informed consent was obtained from the patients and their families for this publication.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u0026nbsp;\\u003c/strong\\u003eData sharing is not applicable to this article as no datasets were generated or analyzed during the current study.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare that they have no competing interests.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u0026nbsp;\\u003c/strong\\u003eThe authors declare that they received no financial support for this work.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions:\\u0026nbsp;\\u003c/strong\\u003eKI served as the attending physician. KK, YT, YO, KM, and KY were members of the treatment team and acted as supervisors. All authors contributed to patient care, discussed the clinical findings, and reviewed and approved the final manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements:\\u0026nbsp;\\u003c/strong\\u003eWe sincerely thank the patients and their families for their cooperation in this study.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eKeschner M, Bender MB, Strauss I. Mental symptoms associated with brain tumor: a study of 530 verified cases. 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Schizophrenia and cognitive dysmetria: a positron-emission tomography study of dysfunctional prefrontal-thalamic-cerebellar circuitry. Proc Natl Acad Sci U S A. 1996;93(18):9985\\u0026ndash;90. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1073/pnas.93.18.9985]\\u003c/span\\u003e\\u003cspan address=\\\"10.1073/pnas.93.18.9985]\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eCierpka M, Wolf ND, Kubera KM, Schmitgen MM, Vasic N, Frasch K, et al. Cerebellar Contributions to Persistent Auditory Verbal Hallucinations in Patients with Schizophrenia. 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First episode psychosis and an underlying cerebellar tumour. Ir J Psychol Med. 2011;28(4):229\\u0026ndash;31. [DOI: 10.1017/S0790966700011733].\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eSandyk R. Psychotic behavior associated with cerebellar pathology. Int J Neurosci. 1993;71(1\\u0026ndash;4):1\\u0026ndash;7. [DOI: 10.3109/00207459309000586].\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eVaquerizo-Serrano J, Salazar de Pablo G, Singh J, Santosh P. Autism Spectrum Disorder and Clinical High Risk for Psychosis: A Systematic Review and Meta-analysis. J Autism Dev Disord. 2022;52:1568\\u0026ndash;86. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s10803-021-05046-0]\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10803-021-05046-0]\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e\\u003cli\\u003e\\u003cspan\\u003eYeruva RR, Shang Y, Schoenbachler B, Nuss S, El-Mallakh RS. Anatomical association between schizophrenia and cerebellum. Innov Clin Neurosci. 2021;18(7\\u0026ndash;9):47\\u0026ndash;9.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-psychiatry\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bpsy\",\"sideBox\":\"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bpsy/default.aspx\",\"title\":\"BMC Psychiatry\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Cerebellar Pilocytic Astrocytoma, Autism Spectrum Disorder, Psychosis, Schizophrenia, Brain Tumor, Hallucination\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-7712199/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-7712199/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e\\u003cp\\u003ePsychiatric 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 case is noteworthy due to its unique combination of a cerebellar tumor and psychotic symptoms in a patient with autism spectrum disorder (ASD) traits.\\u003c/p\\u003e\\u003ch2\\u003eCase presentation:\\u003c/h2\\u003e\\u003cp\\u003eA 16-year-old male with longstanding ASD traits 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 traits. Brain magnetic resonance imaging (MRI) revealed a 3-cm cerebellar mass, which was identified as a pilocytic astrocytoma upon surgical resection. Notably, the patient\\u0026rsquo;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 ASD traits remain unchanged.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e\\u003cp\\u003eThe 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 traits. Given the slow-growing nature of pilocytic astrocytomas, this case highlights the importance of considering cerebellar pathology in the differential diagnosis of psychosis, with implications for understanding disorders like ASD.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Cerebellar Pilocytic Astrocytoma in a Patient with Autism Spectrum Traits and Psychotic Symptoms: A Case Report\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-10-17 15:52:03\",\"doi\":\"10.21203/rs.3.rs-7712199/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2025-10-19T18:28:12+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"294689216021832472637876722267062041006\",\"date\":\"2025-10-19T16:14:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"228301070337736987249825089683103617032\",\"date\":\"2025-10-19T16:10:09+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-18T10:41:49+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"299297452547967814625764898848919507799\",\"date\":\"2025-10-15T06:32:28+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2025-10-15T00:45:14+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"169643624548152182664895727646085845034\",\"date\":\"2025-10-14T13:49:51+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"182255095517788897588938143974325832721\",\"date\":\"2025-10-06T19:56:37+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2025-10-06T19:52:41+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2025-10-03T09:19:38+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-10-03T09:19:17+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Psychiatry\",\"date\":\"2025-09-25T10:59:38+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-psychiatry\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bpsy\",\"sideBox\":\"Learn more about [BMC Psychiatry](http://bmcpsychiatry.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bpsy/default.aspx\",\"title\":\"BMC Psychiatry\",\"twitterHandle\":\"@BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"4e93e9d4-26d5-42f3-aac7-c1cde0efd398\",\"owner\":[],\"postedDate\":\"October 17th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"published-in-journal\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-12-29T16:11:21+00:00\",\"versionOfRecord\":{\"articleIdentity\":\"rs-7712199\",\"link\":\"https://doi.org/10.1186/s12888-025-07706-2\",\"journal\":{\"identity\":\"bmc-psychiatry\",\"isVorOnly\":false,\"title\":\"BMC Psychiatry\"},\"publishedOn\":\"2025-12-25 15:58:06\",\"publishedOnDateReadable\":\"December 25th, 2025\"},\"versionCreatedAt\":\"2025-10-17 15:52:03\",\"video\":\"\",\"vorDoi\":\"10.1186/s12888-025-07706-2\",\"vorDoiUrl\":\"https://doi.org/10.1186/s12888-025-07706-2\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-7712199\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-7712199\",\"identity\":\"rs-7712199\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}