Brain tumors in patients primarly treated psychiatrically

Abstract

Introduction. Psychiatric symptoms are not rare manifestations of brain tumors. Brain tumors presented by symptoms of raised intracranial pressure, focal neurological signs, or convulsions are usually first seen by the neurologist or less frequently by the neurosurgeon in routine diagnostic procedures. On the other hand, when psychiatric symptoms are the first manifestation in ?neurologically silent? brain tumors, the patients are sent to the psychiatrist for the treatment of psychiatric symptoms and brain tumors are left misdiagnosed for a long period of time. Case Report. We presented three patients with the diagnosed brain tumor where psychiatrist had been the first specialist to be consulted. In all three cases neurological examination was generally unremarkable with no focal signs or features of raised intracranial pressure. CT scan demonstrated right insular tumor in a female patient with obsessive-compulsive disorder (OCD); right parietal temporal tumor in a patient with delusions and depression and left frontal tumor in a patient with history of alcohol dependency. Conclusion. Psychiatric symptoms/disorders in patients with brain tumors are not specific enough and can have the same clinical presentation as the genuine psychiatric disorder. Therefore, we emphasize the consideration of neuroimaging in patients with abrupt beginning of psychiatric symptoms, in those with a change in mental status, or when headaches suddenly appear or in cases of treatment resistant psychiatric disorders regardless the lack of neurological symptoms.Uvod. Psihijatrijski simptomi nisu retke klinicke manifestacije tumora mozga. Tumori mozga koji se manifestuju simptomima povisenog intrakranijalnog pritiska, fokalnim neuroloskim znacima i konvulzijama, obicno se dijagnostikuju rutinskim dijagnostickim procedurama od strane neurologa, ili redje, neurohirurga. Medjutim, kod ?neuroloski nemih? tumora, kada se psihijatrijski simptomi javljaju kao prvi znak tumora mozga, bolesnici se upucuju psihijatru koji se bavi lecenjem psihickih smetnji, zbog cega tumori ostaju dugo nedijagnostikovani. Prikaz bolesnika. U radu su prikazana tri bolesnika sa dijagnostikovanim mozdanim tumorom, koji su primarno bili upuceni psihijatru na lecenje zbog psihickih smetnji, dok je neuroloski nalaz kod sva tri bolesnika bio bez fokalnih ispada i povisenog intrakranijalnog pritiska. Kompjuterizovanom tomografijom (KT) kod bolesnika sa opsesivno-kompulzivnim poremecajem i suicidalnim idejama detektovan je tumor u predelu desne insule; kod bolesnika sa paranoidnodepresivnom simptomatologijom ustanovljen je tumor u desnom parijetotemporalnom delu mozga, dok je kod bolesnika sa alkoholizmom ustanovljen tumor u levom frontalnom predelu. Zakljucak. Psihijatrijski simptomi/poremecaji kod tumora mozga nisu dovoljno specificni i mogu imati istovetnu klinicku prezentaciju kao i funkcionalni psihijatrijski poremecaji, posebno u slucajevima ?neuroloski nemih? tumora mozga. Zbog toga, kod bolesnika sa naglim pocetkom psihijatrijskih simptoma, kod pacijenata sa neocekivanim promenama u mentalnom statusu ili kod iznenadne pojave glavobolje, kao i kod terapijski- rezistentnih psihijatrijskih poremecaja, uvek treba imati u vidu i mogucnost udruzenog postojanja tumora mozga. PR Projekat Ministarstva nauke Republike Srbije, br. 175014 i 175007