Acquired mania associated with a left temporal meningioma

Diagnosing Late-Onset Psychosis in a Medically Complex Patient: A Diagnostic Challenge

“…Meningiomas are the most common primary tumors of the brain and frontal meningiomas are known for their late onset, presenting only with psychiatric symptoms [4,5]. Mania, psychosis, and visual hallucinations are the most common manifestations and are mostly associated with right-sided lesions [6,7]. Symptoms usually resolve with resection of the mass as well [6].…”

“…Mania, psychosis, and visual hallucinations are the most common manifestations and are mostly associated with right-sided lesions [6,7]. Symptoms usually resolve with resection of the mass as well [6]. Mania secondary to brain lesions, especially affecting frontal, temporal, and subcortical limbic brain areas, should be considered in patients with a history atypical for classic bipolar and first manic episode after age 40 [2].…”

“…However, it is also important to consider that our patient lived alone with no close contacts to attest to whether she was having symptoms in the months before her hospitalization. Because 78% of patients with brain tumors develop psychiatric symptoms and 19% develop hallucinations, neuroimaging is a critical component in diagnosing atypical psychosis [6]. Yet, given the fact that the patient responded to olanzapine which improved her psychosis, this puts mania secondary to meningioma less likely on the differential.…”