An unusual association of headache, epilepsy, and late-onset Kleist’s pseudodepression syndrome in frontal lobe cavernoma of the cerebral left hemisphere

Abstract

Cerebral cavernous angioma or cavernoma is a benign vascular malformation, usually asymptomatic. It is infrequent and often its discovery is incidental, a so-called incidentaloma. However, these lesions can be symptomatic, causing headaches, epilepsy, cerebral hemorrhage and other neurological signs depending on the brain area involved. Frontal localization is responsible for psychiatric disorders, particularly the prefrontal region, leading to prefrontal syndrome, a condition common in all frontal lobe tumors. Psychopathological syndrome can be depression-type, pseudodepression syndrome or maniac-type, pseudomaniac syndrome. Surgical treatment of lesions like this may not always be possible due to their location in eloquent areas. In this study, we describe an unusual association of migraine-like headache, epilepsy and frontal lobe pseudodepression late-onset syndrome in the same patient. We have considered this case interesting mainly for the rarity of both a headache with migraine features and for the late onset of pseudodepression syndrome. Pathophysiology underlying migraine-like headache and that concerning the late-onset pseudodepression frontal lobe syndrome seems to be unclear. This case leads to further hypotheses about the mechanisms responsible for headache syndromes and psychopathological disorders, in the specific case when caused by a cerebral frontal lobe lesion.

Behavioral Seizure in a Patient With a Cavernous Malformation Finding in CT: A Case Report

“…Depression is a common complication in patients with epileptic disorders [ 15 ]. In 2017, a case report was published of a 66-year-old female with a left frontal lobe cavernous malformation associated with a long history of headaches and epilepsy [ 16 ]. Her epilepsy was of partial and generalized types seizures, manifesting as jerky movements of limbs and face accompanied by dizziness and confusion [ 16 ].…”

“…In 2017, a case report was published of a 66-year-old female with a left frontal lobe cavernous malformation associated with a long history of headaches and epilepsy [ 16 ]. Her epilepsy was of partial and generalized types seizures, manifesting as jerky movements of limbs and face accompanied by dizziness and confusion [ 16 ]. She was treated with multiple antiepileptic drugs, including carbamazepine, phenobarbital, lamotrigine, and levetiracetam [ 16 ], in addition to daily flunarizine to relieve her headaches [ 16 ].…”

“…Her epilepsy was of partial and generalized types seizures, manifesting as jerky movements of limbs and face accompanied by dizziness and confusion [ 16 ]. She was treated with multiple antiepileptic drugs, including carbamazepine, phenobarbital, lamotrigine, and levetiracetam [ 16 ], in addition to daily flunarizine to relieve her headaches [ 16 ]. Later in the course of the disease, she developed a psychiatric syndrome called pseudo-depression syndrome presented with apathy, loss of initiative, libido, and mood changes eventually causing depression [ 16 ].…”

“…She was treated with multiple antiepileptic drugs, including carbamazepine, phenobarbital, lamotrigine, and levetiracetam [ 16 ], in addition to daily flunarizine to relieve her headaches [ 16 ]. Later in the course of the disease, she developed a psychiatric syndrome called pseudo-depression syndrome presented with apathy, loss of initiative, libido, and mood changes eventually causing depression [ 16 ]. Paroxetine was administered for her depression with close monitoring of her condition improvement [ 16 ].…”

Catatonia associated with seizures due to parietal cavernoma

“…Cavernoma or cavernous angioma is a blood vessel malformation composed of a “mulberry-like” cluster of dilated thin-walled capillaries. [ 6 ] Cavernoma is believed to be present in 0.5% of the general population, of which 40% develop symptoms such as headache, epilepsy, repeated hemorrhages, or as symptoms of mass effect. There are reports of other cerebrovascular lesions such as cortical venous thrombosis, subarachnoid hemorrhage, subdural hematoma and aneurysms, and structural lesions of the parietal lobe such as biparietal infarct, right hemispheric infarct, arachnoid cyst, and neoplasms presenting as catatonia.…”