A Case Report of Mania and Glioma

Abstract

It is well established that many physical illnesses either present as or have a component of neuropsychiatric symptoms. Moreover, due to cultural or social influences, patients may present their psychiatric illness in form of somatised physical symptoms. It becomes a diagnostic challenge when a patient presents with concurrent primary psychiatric illness and concurrent organic brain disease. Such a scenario is not uncommon in brain degenerative disorders where Central Nervous System malignancy often causes diagnostic confusion when accompanied by psychiatric symptoms. This chapter discusses a case of a patient who, for a long period, was managed for a mood disorder and later discovered to be having a temporo-parieto-frontal brain mass. The patient was a 32 year old female, with a sporadic history of a mood disorder for the past 13 years characterized by episodes of mania and depression. Her first manic episode was at 19 years of age which was treated successfully with antipsychotics and mood stabilizers at a mental institution. She then developed severe but intermittent right sided headaches which were later associated with photophobia and blurred vision but no vomiting, no postural changes and no cognitive or convulsive symptoms. Subsequent CT and MRI scan examinations revealed a right-sided temporo-parieto-frontal brain mass which was successfully surgically resected although she continued to need her psychotropic medications for mood stabilization.

Regardless of how small the statistical numbers are, brain tumors occur and are on a gradual increase in Africa, representing an aspect of potentially curable brain degeneration if caught early. It is therefore highly recommended that neuroimaging be carried out in the following cases: all patients with an index psychiatric episode especially of late onset (>30 years), patients with atypical presentations, patients with psychiatric presentations accompanied by specific neurologic or neurobehavioral changes and patients with poor response to psychopharmacologic treatment.