Psychiatric Symptoms in Patients with Cerebral Endometriosis: A Case Report and Literature Review

Abstract

Endometriosis is a systemic medical condition characterized by endometrial tissue that is abnormally implanted in extrauterine sites, including the central nervous system. In this article, we reported the case of a patient with presumed cerebral endometriosis who was diagnosed with bipolar disorder and panic disorder and systematically reviewed the literature for previously reported neuropsychiatric symptoms in patients with cerebral and cerebellar endometriosis. The PubMed, Scopus, and Web of Science bibliographic databases were searched according to the PRISMA guidelines. Seven previous case reports were found and described. While neurological disturbances dominated the clinical picture in the cases retrieved from the literature, our patient represented the first case to show both neurological and psychiatric manifestations. Atypical features of bipolar disorder including chronic mood instability, mixed episodes, and excitatory interepisodic symptoms were highlighted. During the neuropsychological evaluation, a dysexecutive profile consistent with frontal lobe pathology was evidenced. We hypothesized that the course and features of the illness were largely influenced by the presence of documented brain lesions compatible with endometrial implants, especially in the frontal region. Accordingly, patients with endometriosis who exhibit neurological as well as mental symptoms should be investigated for cerebral lesions.

Association between Female Reproductive Factors and Risk of Dementia

“…When the brain is affected, it presents changes in gray-matter volume and altered gene expression. Some case reports suggest that psychiatric diseases such as depression, anxiety, and bipolar disorder occur more often in patients with endometriosis [91]. The connection between the appearance of dementia and endometriosis is poorly investigated and information about it is very limited.…”

Effects of the gut microbiota and its metabolite short-chain fatty acids on endometriosis

“…Endometriosis often occurs in the pelvic area, including the ovaries, fallopian tubes, peritoneal surface, bladder, rectovaginal septum, and gastrointestinal tract. Distal organ endometriosis has also been reported, such as liver EMS, brain EMS, and chest EMS ( da Costa et al., 2022 ; Elefante et al., 2022 ; Topbas Selcuki et al., 2022 ; Posses Bridi et al., 2023 ). The symptoms of EMS are often pelvic pain, dysmenorrhea, and infertility ( Zondervan et al., 2018 ).…”

Sentient cells as basic units of tissues, organs and organismal physiology

“…Both cancer and endometrial cells construct aberrant organs functioning as tumours and endometrial lesions (Albini et al, 2010;Anderson & Simon, 2020;Bożyk et al, 2022;Chen et al, 2023). This is most dramatically illustrated, albeit rare, when endometrial cells transit up to the brain, invade the cerebellum and trigger ectopic endometrial lesions (Sarma et al, 2004;Elefante et al, 2022). It can be speculated that tumours and endometrial lesions represent aberrant attempts at organogenesis, perhaps constituting deviant forms of failed embryogenesis and development.…”