Total agenesis of corpus callosum: gait disorder in a schizophrenia case

Objective: Corpus callosum plays an integrative role in the transmission of sensitive, motor, and cognitive information coming from the homologous areas of the cerebral hemispheres. Callosal disgenesia is usually detected by the imaging methods that are scheduled for the investtigation of epilepsy or cognitive diseases. The formation of the corpus callosum occurs between 8 and 20 weeks’ gestation. Such as infections, maternal hormonal factors, hypoxi can cause partial or complete agenesis of the corpus callosum. The corpus callosum areas were found to be smaller in the patients having psychotic bipolar disease. The findings in this investigation have been supported by an other group of investigators describing involution in the genu, posterior and isthmus areas. 1,2

Case: A 24 years old, right handed male patient who have been on therapy for 10 years with the diagnosis of having disorganized schizophrenia was referred to our clinic for having ataxia while walking. His history revealed that this ataxic attitude have been present for a year with increasing frequency and severity. His neurological examination showed mild ataxia and was otherwise normal. By primarily keeping in mind the possibility for drug toxicity as the causative factor of this clinical presentation laboratory tests were sent for assessment. The brain magnetic resonance imaging unveiled total agenesis of the corpus callosum. As his history with the walking disorder had a past of a year this led us to think that it could hardly be related with this congenital malformation. His electroencephalogram showed an abnormality in terms of nonspecific slow waves in bilateral temporo-parietal regions. As ataxic walking could also be associated by the polyneuropathy seen in the Andermann’s syndrome we also performed neuroconductive tests as well which turned out to be normal.

Discussion: In this case, it is not very easy to tell in terms of this walking disorder whether it is to be due to the structural anomaly that caused a predisposition for the disease by being developed before the onset of the disease or repetitive attacks or drug therapy. On the other hand, in this patient having attendance of the striking abnormality in the corpus callosum and the evident positive symptoms (delusions, hallucinations) usage of multiple drugs and administration of highest limit doses for the therapy due to the presence of resistance and /or weak response to treatment may be associated with the walking disorder. 1,3