Neuroanatomy (2004) Volume 3 / Pages 12–14
Published online 26 April, 2004 neuroanatomy.org
Large cavum septum pellucidum associated with
posttraumatic stress disorder: a case reportBranislav Filipovic [1, 2]
During routine examination of a patient with posttraumatic stress disorder, a large cavum
septi pellucidi was noted on CT scan. Cava septi pellucidi were seldom reported as a finding
in posttraumatic stress disorders. In our opinion, large cava are only the marks of the brain
susceptibility for various neuropsychiatric diseases and disorders.
 Institute of Anatomy, School of Medicine,
University of Belgrade, Serbia & Montenegro.
 Private Psychiatric Clinics “Katraza” Belgrade,
 Clinics for Child Neurology and Psychiatry,
Clinical Center of Serbia, Belgrade, Serbia &
 Clinical Center “Bezanijska Kosa”, Belgrade,
Received 27 March 2004; accepted 21 April 2004
[septum pellucidum] [cavum] [posttraumatic stress disorder]
sweating. He was ashamed to visit a psychiatrist, despite
An increased prevalence of cava septi pellucidi (CSP) much advice coming from his wife and friends (“They
among patients with posttraumatic stress disorder will say that I am a lunatic”), due to the fear from the
(PTSD) was previously reported , while large CSP, potential neglect of his friends and co-workers and from
isolated or associated with other dismorphogenesis, were the possibility of loosing his job (he was an active soldier
mostly obtained among schizophrenics [2, 3].
at the time, in rank of the sergeant-major). The intensive
fear resulted by flashbacks, avoiding behavior, decreasing
of the frustration tolerance threshold, anxiousness and
Male, born in 1956, right-handed, married, father of two depressive mood, manifested by loss of the interest for
children (son, 17 and daughter, 15) with high school self-care, loss of the will for initializing an attempt.
education level, was a participant of the war in the Nightmares with war scenes became more and more
former Yugoslav republic of Bosnia and Herzegovina. In frequent, his attention became more and more vigilant,
1992, he was wounded, captured and maltreated while and he fell into the “magic circle” from which he could
hospitalized and prisoner of war in a concentration not get out by himself.
camp. He limps today as a consequence of the neglected In his premorbid personality, certain rigidity dominated
bad medical care in the hospital. He has even survived his attitudes, openly expressed in raising children (i.e.,
a slaughter attempt, from which he has a remarkable he was a very strict father), but he has never punished
scar of approximately 11 cm, beginning from the them physically, nor did he have violent outbursts toward
anterior part of the neck, spreading laterally, over the his wife or other persons.
sternocleidomastoid region. He was released in June In the personal anamnesis, when he was 16, he faced an
1995. Three months later, in September, first symptoms early loss of his father, who died in a mine accident in
of PTSD appeared in the form of vegetative symptoms, 1972. He has gave up an offer to continue the education
such as dyspeptic troubles, gastric pain and pirosis, loss in the Military Academy, because he had to take care of
of the appetite, and nightmares, followed by extensive his mother, brother and sister. He was a moderate smoker
eISSN 1303–1775 • pISSN 1303–1783
Neuroanatomy (2004) Volume 3 Pages 12–14 |
Filipovic et al.
office. He was admitted shortly after, and he underwent
standard CT scan procedure (he could not afford MRI
scanning, because social insurance was unable to cover
his treatment), where a large CSP (8x19 mm, Figure 1)
was obtained, without signs of cortical or subcortical
brain atrophy in any brain region. The same finding
persisted in control CTs performed every six months.
Electroencephalogram did not reveal any oddities in his
brain activity. Psychometric evaluation showed the patient to have an
average intelligence. MMPI-2 showed a high depressive
peak, and he scored 19 on Hamilton Anxiety Rating
Scale and 27 on Hamilton Depression Rating Scale.
Beck Depression Inventory score was 43. There was no
Initially, he was treated with antidepressant amitriptyline
in doses of 40 mg pro die, divided in two equal doses
administrated morning and evening. Anxyolytic therapy
consisted of bromazepam in doses of 3 mg, three times
per day. He was also advised to visit a psychotherapist,
which he refused. All the efforts for his treatment
remained without response over next few years, even
after his pharmacotherapy changes (amitriptyline was
replaced by clomipramine, and carbamazepine and
cinerazine were added), but his psychological state did
not get worse, either. Our pharmacotherapy consisted of
sertraline, in a single dose of 50 mg/day, combined with
hypnotic brotiazolam, and his state slightly improved
CT scan of cavum septi pellucidi (CSP) in our patient.
after six weeks. Actually, he can take care of himself
Frontal horns of the lateral ventricle (FH-LV). Head of the caudate
reasonably well, his nightmares have almost disappeared.
His social life is increasingly improving, but he is still
(less than a box of cigarettes) and his consumption of under the same medication and the strong surveillance
alcohol beverages was reduced to socially acceptable of his wife.
circumstances. According to the data obtained from Discussion
his wife, he was a very thoughtful husband and father, The large CSP finding has not been reported yet in PTSD
and a devoted friend. His military record and the suffering persons, according to the available literature
observation of his superior officers from his file were
sources. The septum pellucidum cave in our patient
could be considered as a large one, according to criteria
He denied receiving serious head blows in the settled by Nopoulos et al. , who stated that cava
concentration camp and before or after that period. greater than 6 mm in length could be taken as abnormally
There was no evidence of loss of consciousness or crisis large. Higher prevalence of large cava septi pellucidi was
in his anamnesis or medical history.
revealed in schizophrenics, developmentally delayed
He has addressed the psychiatrist for help in May 1996, population, and, in relatively lower percentage, in brains
faced with threat by his wife. The PTSD diagnosis was of aggressive persons and alcoholics [4–10]. MRI guided
established after the first session, according to criteria study on patients suffering from PTSD showed that 50%
from 10th revision of the International Classification of them had a detectable small CSP . It is probable that
of Diseases. In 1999, he came to Belgrade, asking for large CSP is a congenital brain midline malformation
legal advice in order to get reimbursement from the which indicates inborn susceptibility of the brain to
Army, and he was recommended to visit our psychiatric neuropsychiatric disorders, including PTSD.
 Myslobodsky MS, Glicksohn J, Singer J, Stern M, Bar-Ziv J,
 Nopoulos P, Krie A, Andreasen NC. Enlarged cavum septi
Friedland N, Bleich A. Changes of brain anatomy in patients
pellucidi in patients with schizophrenia: clinical and cognitive
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imaging study. Psychiatry Res. 1995 (58) 259–264.
 Nopoulos PC, Giedd JN, Andreasen NC, Rapoport JL. Frequency
 Mott SH, Bodensteiner JB, Allan WC. The cavum septi pellucidi
and severity of enlarged cavum septi pellucidi in childhood-
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onset schizophrenia. Am. J. Psychiatry. 1998 (155) 1074–1079.
Neuroanatomy (2004) Volume 3 Pages 12–14 |
Filipovic et al.
 DeLisi LE, Hoff AL, Kuschner M, Degreef G. Increased
 Filipovic B, Teofilovski-Parapid G, Stojicic M. Comparative
prevalence of cavum septum pellucidum in schizophrenia.
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schizophrenics and aggressive persons. Folia Morphol. (Warsz).
 Bodensteiner JB, Schaefer GB, Craft JM. Cavum septi pellucidi
and cavum vergae in normal and developmentally delayed
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damage due to boxing. Neuroradiology. 2000 (42) 1–8.
 Filipovic B, Teofilovski-Parapid G. Ageing changes of
 Kacinski M, Kubik A, Pakszys M, Gergont A, Prajsner B.
morphological characteristics of cavum septi pellucidi in adults:
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