Q: Based on this clinical history, list some of the differential diagnoses? show answer
Frontal meningioma and schizophrenia
This patient presented with a three-month history of persecutory delusions, personality change, amotivation and cognitive impairment. She exhibited memory deficits, dyscalculia, left-right disorientation, and dyspraxia. She also complained of headaches. Background of 25-year history of schizophrenia, which had been stable for ten years on antipsychotic treatment.
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MRI brain with contrast
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Imaging demonstrates a 3 cm mass located anteriorly in the interhemispheric fissure, between the frontal lobes and above the corpus callosum which it distorts. The mass demonstrated a low signal centrally on all sequences, in keeping with calcification, and a rim of enhancing tissue around the periphery. Extensive vasogenic oedema involving both frontal lobes was seen as a high T2 signal on the axial FLAIR. There was no appreciable diffusion restriction and the remainder of the brain was unremarkable.
The imaging was consistent with a frontal falcine meningioma. This was surgically excised, and the diagnosis was histopathologically confirmed. Her symptoms resolved.
In patients with a history of mental illness, symptoms of frontal meningioma may mimic those of a psychotic relapse and lead to a delay in diagnosis. As meningiomas are amenable to treatment by surgical resection, it is important to recognise atypical psychotic presentations and investigate these appropriately.