Psychiatric manifestations of brain tumors: diagnostic implications

Abstract

Brain tumors can cause any type of psychiatric symptoms. Rarely, brain tumors can present without any localizing signs but with psychiatric symptoms. A review of the literature indicates that there is no association between psychiatric symptoms and tumor location or histological type. Hence, it is important for clinicians to have an index of suspicion of brain tumor in patients with new-onset psychiatric symptoms, atypical presentations and treatment resistance and, as a result, consider neuroimaging. Early detection is of paramount importance for treatment and quality of life of patients. Mood symptoms may herald a brain tumor. For example, anorexia can be a presenting symptom of hypothalamic tumors. A prospective controlled study will be of benefit to further assess the association between psychiatric symptoms and brain tumor locations. New developments in the diagnostic and treatment area of brain tumors would be of help in undertaking such a prospective study.

Meningiomatosis revealed by a major depressive syndrome

“…We recommend brain imaging in cases with some abnormalities in a neurological examination, or in the absence of neurological signs, in the following cases: (1) late onset of depressive syndrome (after 50 years of age); (2) treatment-resistant depression; (3) apathy without dysphoric manifestations or with a reduced emotional response. In addition, Madhusoodanan et al 15 suggested that neuroimaging must be considered when there is an index of suspicion, such as new-onset psychosis, new-onset mood/memory symptoms, occurrence of new or atypical psychiatric symptoms, new-onset personality changes and anorexia without body dysmorphic symptoms.…”

Brain germinoma presenting as a first psychotic episode in an adolescent male

“…These symptoms are very unspecific. A recent review of the literature concluded that neither tumor type nor location is associated with any particular psychiatric manifestation [6].…”

“…A wide variety of these syndromes have been reported since Dr John Harlow's description of his patient Phineas Gage more than 150 years ago [4]. These syndromes have included personality changes, psychosis, obsessive-compulsive symptoms, depression, anxiety disorders, mania, cognitive deterioration and anorexia nervosa [1,5,6]. Most reports describe tumors of the frontal or temporal lobes, and very few discuss the psychiatric sequelae of tumors primarily affecting subcortical structures [7,13].…”

Cerebral Malignancy Presenting with Post Stroke Depression

“…In general parietal lobe tumors are ''silent'' with respect to psychiatric symptoms [8]. The affective symptoms in these patients are predominantly depression and apathy.…”