A Rare Presentation of Quadrigeminal Cistern (Tectal Plate) Lipoma With Visual Hallucinations in a Patient of Schizophrenia: A Case Report

Intracranial lipomas are rare benign congenital tumours, consisting of <0.1% of all primary brain tumours. They are asymptomatic and are thus incidentally discovered whenever brain imaging is advised due to any other organic cause. These lipomas can rarely present with acute psychosis or schizophrenia-like symptoms characterised by abnormal perceptions, cognition, mood, and behaviour. One of the most frequent symptoms of schizophrenia is hallucination. In patients with schizophrenia, hallucinatory experiences can have an impact on any of the five senses; however, auditory hallucinations are the most common. Although tactile, olfactory, and gustatory hallucinations are uncommon, visual hallucinations are also frequently experienced; their existence should prompt a clinician to think about whether there may be an underlying medical or neurological condition that is the root of the entire syndrome. Thus, the presence of visual hallucinations in a patient with psychosis should not be neglected and brain imaging should be done to rule out any organic brain disease. Schizophrenia-like symptoms in a patient of quadrigeminal lipoma are rare and not many cases have been reported in this context. Quadrigeminal lipoma presenting with headache, seizure, loss of consciousness, and aggression has been reported but not with acute psychosis or schizophrenia. Hereby, we report a case of a 35-year-old female who presented with psychosis with predominant visual hallucinations, which suspected an underlying organic pathology and brain imaging showed the presence of quadrigeminal cistern lipoma. The idea behind choosing this case is to report a very rare condition with an even more atypical associated presentation.