Bipolar Disorder Secondary to Arnold–Chiari Malformation: A Rare Case Report

A handful of case reports suggesting Arnold–Chiari malformation (ACM) comorbid with psychiatric diagnoses have been reported in the literature, but the association with bipolar disorder is rare. Here, we report a case of the first episode of mania secondary to Chiari malformation. A 16-year-old female presents with irritability, headache, decreased sleep, increased talking, weeping episodes, and verbal and physical aggression for 15 days. Symptoms gradually increased with dizziness, headache, epistaxis, and generalized decreased superficial sensation to pain. She was managed as an inpatient in the psychiatric setting as a case of first episode mania on valproate, olanzapine, and lorazepam, which were further escalated a few days later. A brain magnetic resonance imaging was performed, which revealed ACM Type 1. Further, mood stabilizers and antipsychotics were titrated, and symptoms improved. Our case report highlights the importance of considering neurologic causes manifesting as psychiatric symptoms.