Psychiatric symptoms – single manifestation of left

thalamic tumor in adolescent – case report

Florina Rad1, Alexandra Buica2, Alina Stan, Georgiana Grigore3, Cristina Anghel3, Liana Kobylinska4, Iuliana Dobrescu1

Psychiatric symptoms such as mood disorders, anxiety, obsessive ideas and compulsions, psychotic symptoms, memory disorders,
conduct disorders, personality traits changes, can be found in a variety of organic disorders including brain tumors. In rare cases
psychiatric symptoms are single manifestations of a brain tumor. The majority of large studies discussing brain neoplasms and
psychiatric symptoms date back to the 1930’s. Since psychiatric nomenclature and disease parameters change constantly, it is
difficult to analyze this topic in a consistent manner.

Cases of two adolescent girls,

where psychiatric symptoms were
correlated with the existence of
brain tumors.

- the case of a 16 years old girl who is presenting with her parents, to Child and
Adolescent Psychiatry Department of “Prof. Dr. Alexandru Obregia” Hospital
from Bucharest after two years of treatment with antidepressant medication - the case of a 14 years old girl to whom severe obsessive compulsive

(Sertralinum) for recurrent, treatment resistant depressive disorder with disorder started after neurosurgical intervention for a left thalamic tumor

psychotic symptoms. (glial astrocytoma).

- clinical picture : anhedonia, lack of interest and pleasure, marked sadness, - the pacient had no history of psychiatric disorders prior the moment when

social withdrawal, insomnia, fatigue, low self-esteem, suicidal ideation, she referred to our clinic, at four years after surgical excision of the tumor.

affective inversion for the mother, multiple somatic complaints and visual - at that moment, the pacient presented obsessive ideas and images

perception modifications (auditory and visual hallucinations) accompanied by compulsions and mood fluctuations.

- neurological exam- within normal limits - Augmented intensity of symptoms and treatment resistance after several

- electroencephalographic examination has not revealed paroxysmal months of medication imposed repeating brain imaging.

manifestations. - Brain MRI revealed no tumor recurrence and it couldn’t be identified a

- persistent symptoms were resistant to antidepressant treatment that she somatic cause of the disorder.

received over the time, the medical team decided to submit the pacient to brain - Treatment with antidepressant augmented by antipsychotic medication,

imaging. Brain MRI has revealed a left thalamic hamartoma in the absence of doubled with cognitive behavioral psychotherapy program has brought

neurological signs. minimum benefits in this case.

- neurosurgical consult : timing of surgical approach and imaging

monitorization
- persistence of depressive and psychotic symptoms: it was decided to
administer paroxetine and risperidone (favorable results on perceptual
disfunctions but with moderate effects on depressive symptoms)

In case of sudden onset of psychiatric disorders with atypical or treatment resistant symptoms, neuroimaging assessment must be
proceeded, because early detection of brain tumors is extremely important in terms of therapeutic approach. Early diagnosis is critical for
improved quality of life

Brain tumors have been associated with the presence of psychiatric symptoms in the literature. In several cases resolve of psychiatric
symptoms has been documented after surgical treatment for these tumors

The exposure of this cases highlights the importance of multidisciplinary team in the management of those comorbidities: psychiatrist,
radiologist, neurologist, neurosurgeon and psychologist
1. Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy “Carol Davila” “Prof.
Dr. Al. Obregia” Psychiatry Hospital, Bucharest, Romania, florina2rad@yahoo.com
2. Child and Adolescent Psychiatry Department, University of Medicine and Pharmacy “Carol Davila”
DISCLOSURE
Bucharest, Romania
3. Child and Adolescent Psychiatry Department, “Prof. Dr. Al. Obregia” Psychiatry Hospital, Bucharest
Nothing to disclose.
4. Neurophysiology Department, University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania