Temporal glioblastoma presenting as catatonia

Abstract

The objective of this article is to describe the possible association of catatonia and temporal brain lesions. This is a case presentation of a 57-year-old man presenting with depression, with catatonia secondary to a temporal glioblastoma. He was referred to hospital because for a sudden deterioration in depressed state. He was diagnosed with catatonia and treated successfully with lorazepam. During his admission, he became increasingly disinhibited, and an MRI scan revealed an intracranial mass in the right temporal lobe, with uncal herniation and a mass effect. Surgical resection of the entire tumour was successful. Histological examination revealed a glioblastoma multiforme requiring additional chemoradiotherapy. Postoperatively, catatonic signs and symptoms were not detectable. A postsurgical frontal syndrome with disinhibition and logorrhoea was present and gradually normalised over the course of several weeks. Catatonia can be the presenting symptom of a temporal brain tumour, and should therefore prompt the physician to a thorough medical investigation.

Subtle neuropsychiatric symptoms of glioblastoma multiforme misdiagnosed as depression

“…Mood disorders were associated with tumours involving the frontal lobes,10 12–14 22–25 34 temporal lobes14 16 17 20 30 and limbic structures 17 31. Patients manifested psychotic symptoms in 35% (9/26) of cases 11 15 22 25–28 30 32. Psychotic symptoms tended to be predominantly associated with tumours localised in the temporal lobes,15 26 27 30 31 although some of the cases reported here also traced the emergence of psychotic symptoms to tumours predominantly effecting the frontal lobes11 22 25 and corpus callosum 28 32.…”

“…The emergence of psychiatric symptoms may be the initial, and often insidious, sign of an evolving GBM. In several of the cases summarised here, it was the psychiatric symptoms that prompted clinical presentation 3 10 13 14 16 17 20–23 26–28 30 31. Psychiatric manifestations related to GBM in the cases retrieved here have been reported in adults whose ages spanned 24–65 years; most (62%) of the afflicted persons were middle-aged.…”

“…Patients manifested psychotic symptoms in 35% (9/26) of cases 11 15 22 25–28 30 32. Psychotic symptoms tended to be predominantly associated with tumours localised in the temporal lobes,15 26 27 30 31 although some of the cases reported here also traced the emergence of psychotic symptoms to tumours predominantly effecting the frontal lobes11 22 25 and corpus callosum 28 32. There was a paucity of GBM cases involving the parietal lobe and none involving the occipital lobes; it has been argued that such tumours tend to be relatively ‘silent’ with regard to psychiatric manifestations 17 31 35 36…”

“…Depression was the primary psychiatric symptom manifestation of the underlying GBM in 62% (16/26) of retrieved cases 3 10 13 14 16–18 20–23 25 28 30 32 33. Other mood disturbances reported among GBM patients included pseudobulbar affect-like states,24 manic-like states27 31 and anxiety,3 12 13 17 34 some of the latter of which co-occurred in depressed patients.…”

“…Other mood disturbances reported among GBM patients included pseudobulbar affect-like states,24 manic-like states27 31 and anxiety,3 12 13 17 34 some of the latter of which co-occurred in depressed patients. Mood disorders were associated with tumours involving the frontal lobes,10 12–14 22–25 34 temporal lobes14 16 17 20 30 and limbic structures 17 31. Patients manifested psychotic symptoms in 35% (9/26) of cases 11 15 22 25–28 30 32.…”