Psychiatric symptoms like mania, hallucinations, and depression may signal a brain tumor, according to doctors who diagnosed a 54-year-old woman with treatment-resistant depression.

The patient, who was not named for confidentiality of the case study, had stopped showing interest in her past hobbies. She spent more time in bed and always felt irritable. Tests show no abnormality so doctors initially prescribed antidepressants.

All treatment options did not work. After six months of being in a depressive mood, doctors found she had several tumors in her brain shown through MRI (magnetic resonance imaging) and CT (computed tomography) scans. These tumors were found in her left frontal lobe, which is linked to depressive symptoms.

In the case report published in BMJ Case Reports, doctors found the patient had meningiomatosis or multiple meningiomas. Meningiomas are tumors that grow from the meninges, the membranes surrounding the brain and spinal cord. A big meningioma was found in her left frontal lobe.

The woman underwent surgery to remove the tumor. Though the tumor was benign, it caused alterations in her emotions because it was attached to her frontal lobe.

"Depressive symptoms may be the only expression of brain tumors. Thus, it is challenging to suspect a brain tumor when patients with depression have a normal neurological examination," the doctors wrote in the case report.

"This case highlights the importance of identifying signs of brain tumour in patients with depression," they added.

Depressive symptoms stopped a month after her operation and her life returned to normal. Doctors recommended that brain scans should be performed if one presents late onset of depressive symptoms or if these symptoms manifest after 50 years of age.

"Although there is no consensus about whether brain imaging is indicated for depressive syndromes, it should be performed, particularly in late onset of depressive syndrome (after 50 years of age), treatment-resistant depression or in apathy with a reduced emotional response or without dysphoric manifestations," the researchers said.

What Are Meningiomas?

Meningiomas are usually benign tumors arising from meninges, the protective covering of the brain and spinal cord. Despite being dubbed brain tumors, they do not actually grow from brain tissue. Instead, they grow from the meninges.

The main cause of these tumors is unknown but between 40 and 80 percent of meningiomas contains an abnormal chromosome 22.

These tumors grow slowly and if they reach a large size, they can interfere with the normal functions of the brain. The symptoms may depend on the location in the brain or spinal cord. Generally, people with meningioma may experience headache, weakness in the extremities, seizures, and personality changes.

The American Brain Tumor Association reported that around 36.1 percent of all primary brain tumors are meningiomas. They are found in adults more than 60 years old and the incidence increases with age. Women are also affected more than men.

The Frontal Lobe Of The Brain And Its Functions

The frontal lobe controls motor skills, conscious thought, personality, and emotions. It is basically the region of the brain which depicts "who you are." It deals with emotional, motor, social, and sexual behavior. Memory, decision-making and problem solving skills are also part of its functions.

The left frontal lobe deals with logical thinking and positive emotions. When there is damage to the left frontal lobe, it can affect positive emotions. Behavior, mood, and personality may also be affected. Since the emotions are affected, the symptoms felt may cause a person to become impulsive, depressed or anxious.

Photo: Allan Ajifo | Flickr