Frontal Lobe Meningioma Masquerading as Depressive Disorder

Meningiomas are a diverse set of tumors thought to arise from the arachnoid cap cells, which reside in the arachnoid layer covering the surface of the brain. Meningiomas account for approximately 25% of all primary intracranial neoplasms; most of them are benign and their incidence increases with age. These tumors can arise anywhere, most commonly within the skull and at sites of dural reflection (falx cerebri, tentorium cerebelli, venous sinuses. Meningiomas are extremely slowed growing and often asymptomatic. Small tumors (e.g., <2.0 cm) are usually incidental findingsat autopsy without having caused symptoms. Larger tumors can cause symptoms depending on the size and location. The frontal lobes of the brain are notoriously “silent”: Benign tumors such as meningiomas that compress the frontal lobes from the outside may not produce any symptoms other than progressive change of personality and intellect until they are large. Patients with such tumors are often referred first to psychiatrists, and the correct diagnosis may emerge only when the tumor has grown large and has begun to displace the brain.

Case History: A 60 year old female was brought to psychiatric outpatient department with two months history of headache and altered behavior in form of remaining aloof, not talking much and remaining sad and gloomy most of the time. She had no past or family history of any psychiatric illness. There was no history of any co morbid medical condition or substance abuse. Upon further enquiry, the patient acknowledged having lost interest in all pleasurable activities and feeling easily fatigued by minor activities. In addition she complained of lack of sleep and appetite since past month. On Mental State Examination she was an elderly female, well kempt with decreased psychomotor activity. Rapport was easily established. Her speech was non spontaneous, low in volume and tone with increased reaction time. She verbalized her mood as “low” but attributed it to constant headache that was bothering her. Her affect was depressed. Read more...............