Frontal meningioma and schizophrenia

Case contributed by Dr Gabrielle Matta

Presentation

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.

Patient Data

Age: 70
Gender: Female
MRI

MRI brain with contrast

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.

Case Discussion

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.

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Case information

rID: 43937
Case created: 30th Mar 2016
Last edited: 10th Apr 2016
Inclusion in quiz mode: Included

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