Melanoma brain metastases presenting as delirium: a case report

Abstract

Background: Metastatic tumours sometimes present with neuropsychiatric symptoms, however psychiatric symptoms as rarely the first clinical manifestation. Cutaneous melanoma is the third most common cause of brain metastasis, with known risk factors increasing the chance of such central nervous system metastization. Objectives: We present a clinical report of delirium as the first clinical manifestation of melanoma brain metastases, illustrating the relevance of an adequate and early differential diagnosis. Methods: In addition to describing the clinical case, searches were undertaken in PubMed and other databases using keywords such as "brain metastasis", "melanoma", "agitation", "psychiatric" and "delirium". Results: We here report the case of a 52-year-old female patient evaluated by Liaison Psychiatry after sudden onset of delirium while admitted at the Gastroenterology Department to study a hypothesis of pancreatitis. A head CT scan identified brain metastases, and after further examination, including brain biopsy, melanoma brain metastization was confirmed. Discussion: Some of the diagnostic challenges of psychiatric symptoms associated with secondary brain tumours are discussed, underlining the importance of an adequate differential diagnosis when working in Psychiatry Liaison.

Sudden Death from Primary Cerebral Melanoma: Clinical Signs and Pathological Observations

“…The patient had a history of drug addiction, presenting psychomotor agitation and aggressive behavior, as can be observed in many cerebral neoplasms [ 54 , 55 , 56 , 57 ]. Morais described a case of delirium in a patient with brain melanoma metastases [ 58 ] and other authors reported headache and diplopia in a 27-year-old man affected by primary meningeal melanocytoma in the anterior cranial fossa [ 59 ]. However, we can ascribe the first presented symptoms (headache and vomit) to increased intracranial pressure, probably due to the increased neoplastic mass in the posterior fossa and a subarachnoid hemorrhage.…”

Aspetos psiquiátricos dos tumores do sistema nervoso central

“…Em fases ini ciais, quadros de delirium hipoativo podem ser interpretados como depressão. Em situações raras, o delirium pode ser a manifestação inicial de lesões neoplásicas no SNC 15 . A abordagem do delirium compreende de início a identificação e a correção, sempre que possível, de causas subjacentes (vide Quadro 2).…”