A Case Report of Mania and Glioma

Fig. 18.1

Image of SK’s brain MRI

In order to exclude metastases in other areas, a chest x-ray, mammogram and abdominal-pelvic ultra sound scan were done and all were found normal.

A working diagnosis of Bipolar Affective Disorder, hypomanic phase with organic brain disease (brain tumor) plus syndrome X was made.

Treatment

Neuropsychiatric symptoms were treated and stabilized with Risperidone 2 mg OD, Carbamazepine 400 mg B.I.D, Acetazolamide 250 mg Q.I.D, Mannitol 100 mg Q.I.D and Dexamethazone 4 mg T.I.D
Diabetes mellitus and Hypertension were controlled with: Amilodipine 10 mg OD, Losartan-H 6.25 mg OD, Artrovastatin 10 mg OD, Piosafe 1 tablet pre-breakfast and pre-supper, soluble insulin 5–20 I.U depending on the blood glucose levels.

SK’s family requested that she gets referred abroad for a second opinion and treatment. After 2 weeks of admission, the patient’s psychiatric symptoms had improved and she was transferred to India for further treatment after consultation with an oncologist. Management of SK in India involved tumor excision surgery. Pathological studies of excisional biopsy showed Fibrillary astrocytoma of the right parieto-occipito-temporal lobe.

The post surgical period of SK was characterized by a 2 months period of remission of her psychiatric and lateralizing neurological symptoms. However, twice from the time of surgery, she had had two admissions in a mental health facility with manic symptoms which have now stabilized for 2 years on mood stabilizers. Her previous and regular medications of mood stabilizers had been maintained throughout this entire period. SK continues to enjoy good mental and physical functioning on medication and follow up monitoring post-surgically.

Discussion

This case demonstrates the diagnostic challenges and dilemmas usually faced in resource constrained facilities of this world where patients often present with complex physical (CNS) and psychiatric disorders. One wonders whether this was a case of a brain tumor that was not diagnosed earlier, manifesting with psychiatric symptoms, or merely a coincidental misfortune of having both a brain tumor and a primary psychiatric condition at the same time.

In this particular case, SK had suffered from a manic episode at 19 years of age. She was treated and went on to live normally off medication for the next 10 years. When these manic symptoms resurfaced 10 years later, it was evident that her mental illness had become less responsive to medication, with her symptoms recurring more frequently. This is the period that her headaches become more severe and frequent. Perhaps this could have been the result of now an enlarged tumor that was not caught early at onset.

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