Electroconvulsive treatment of a bipolar adolescent postcraniotomy for brain stem astrocytoma

This is the first reported use of electroconvulsive treatment (ECT) in an a dolescent with bipolar mania who had been treated with craniectomy for an i ntracranial neoplasm. The reported case is of a 16-year-old girl with a his tory of brain stem glioma (pontomesencephalic astrocytoma) diagnosed at 13 years of age. She presented in a psychiatric emergency room with suicidal i deation, depressed mood, irritability, olfactory hallucinations, early inso mnia, grandiosity, and guilt. Her symptoms failed to respond to a trial of an antidepressant, mood stabilizer alone, and mood stabilizer in conjunctio n with a neuroleptic. The decision to use ECT was based on suicidal ideatio n, extreme disinhibition, and danger to self and others. Significant improv ement in mood and remission in psychosis were noted after the eighth treatm ent. Comparison of 2-week pre-ECT and 3-month post-ECT cognitive testing re vealed no change in IQ. This report highlights rapid response and the abili ty to tolerate ECT in an adolescent diagnosed with bipolar disorder, who ha d also been treated with radiation and craniotomy.