DOI: https://doi.org/10.36347/sjmcr.2025.v13i07.052

Pages: 1725-1727

Introduction: Arachnoid cysts are benign lesions often discovered incidentally through brain imaging. Though classically asymptomatic, recent case reports suggest a possible association with psychiatric symptoms, particularly psychosis. This raises important diagnostic and therapeutic challenges. Case Reports: Case 1: A 27-year-old man with a 4-year history of schizophrenia was admitted for aggressive behavior, soliloquy, and persecutory and religious delusions. His history included substance use, suicide attempts, and a past head trauma. Brain MRI revealed a large right temporal arachnoid cyst with mass effect. Treated with risperidone, he showed partial improvement. No surgical intervention was indicated. Case 2: A 42-year-old woman with a 10-year history of schizophrenia presented with aggressive behavior and mystic-persecutory delusions. MRI showed a large left Sylvian fissure arachnoid cyst. Treated with aripiprazole, her symptoms improved but did not fully remit. No surgery was performed. Discussion: Both patients displayed psychotic symptoms without clear features distinguishing functional from organic origins. The possible link between arachnoid cysts and psychiatric symptoms remains debated. Some literature supports symptom remission after surgical removal; others note improvement with pharmacological treatment alone. Factors supporting a causal role include absence of family history, mass effect, and neuropsychological abnormalities. Conclusion: While the direct contribution of arachnoid cysts to psychiatric symptoms remains uncertain, their presence warrants careful consideration in therapeutic planning, including the potential role of surgery.