Meningiomas are tumors which arise from arachnoid cells and can occur both in the brain and spinal cord. Meningiomas can present with psychiatric symptoms (such as depression, anxiety disorders, or personality changes) in the absence of any neurologic signs or symptoms.

1. Right Temporal Lobe Meningioma presenting as postpartum
depression: A case report

2. a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 2 9 9 e3 0 1
Available online at www.sciencedirect.com
journal homepage: www.elsevier.com/locate/apme
Case Report
Right Temporal Lobe Meningioma presenting as
postpartum depression: A case report
Tarun Kumar a,*, Archana Kathpal a, Carrol T. Longshore b
a
Resident, Department of Psychiatry, Elmhurst Hospital Center (Mount Sinai School of Medicine), 79-01 Broadway,
Elmhurst, NY 11373, United States
b
Attending and Head, Adult Psychiatry Inpatient Unit, Elmhurst Hospital Center (Mount Sinai School of Medicine),
79-01 Broadway, Elmhurst, NY 11373, United States
article info
abstract
Article history:
Meningiomas are tumors which arise from arachnoid cells and can occur both in the brain
Received 31 August 2012
and spinal cord. Meningiomas can present with psychiatric symptoms (such as depression,
Accepted 31 January 2013
anxiety disorders, or personality changes) in the absence of any neurologic signs or
Available online 20 February 2013
symptoms. Literature review also shows few cases of postpartum depression seen in association with Frontal Lobe Meningiomas. Authors in this article present a unique case of
Keywords:
Right Temporal Lobe Meningioma in a patient, who presented with chief complaint
Meningioma
of postpartum depression. This presentation has never been reported to date. Routine use
Postpartum depression
of neuroimaging in the evaluation of new onset psychiatric disorders has always been
Neuroimaging
controversial but this case clearly underscores the value of a detailed history, careful
physical examination, and consideration of other diagnostic studies in patients presenting
for psychiatric evaluation. This case also provides an opportunity for clinical departments
to improve and redefine its protocols and management strategies.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1.
Introduction
Meningioma is brain tumors that arise from arachnoid cells
lining brain and spinal cord. These usually occur spontaneously, or secondary to radiation exposure. Incident rate of
these tumors is about 7.8% per 100,000 per year.1 Most of these
tumors remain silent and only 25% of them produce symptoms based on their location.2e5 These tumors have been
associated with depression, mania, psychosis and personality
changes. These tumors can be easily diagnosed by using
neuroimaging but the use of neuroimaging such as CT scan in
the evaluation of new onset psychiatric disorders has always
been a topic of debate.
Postpartum depression is a form of clinical depression
which begins after child birth. It may last up to several months
or even a year. In the past, a case of postpartum depression
secondary to bifrontal meningioma has been reported but we
recently had a case of right temporal meningioma which
presented as postpartum depression.
2.
Case report
Ms Y is a 28-year-old Asian female with no prior psychiatric
treatment who presented to psychiatry walk-in clinic at our
hospital with symptoms of depressed mood, anhedonia,
* Corresponding author.
E-mail address: drtarundhingra@gmail.com (T. Kumar).
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.apme.2013.01.018

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fatigue, decreased concentration, and difficulty sleeping of 8
months duration. As per Ms Y, her symptoms started just
2e3 weeks after the birth of her first child. Along with
depressive symptoms, she reported mild headache, occasional dizziness, and nausea. She lost interest in her former
hobbies and also reported lack of motivation to take care of
the baby but she managed to do so. She denied having any
suicidal or homicidal ideations toward self, her baby or any
other individual. The pregnancy was planned.
She did not seek any help for about 5 months but later was
referred to a psychiatrist by her primary physician. She did not
seek help of a psychiatrist and took some herbal medications
for depression which made the symptoms worse. Later at the
request of a friend, she came to our walk-in clinic. Ms Y presented with depressed mood, anhedonia, psychomotor
retardation with poor sleep and appetite. Her speech was of
normal volume, rate and rhythm. She denied any suicidal or
homicidal ideations along with denying any psychotic symptoms. Except for a history of miscarriage at the age of 22, Ms Y
denied having any medical problems. She reported having
headaches (mentioned above) for about 8 months with occasional double vision. She was referred for a regular physical
exam (which includes a brief neurological exam) which was
reported as normal. Routine blood work including toxicology
screen were normal. CT scan was ordered for which she got
appointment in 2 weeks. Ms Y was diagnosed with postpartum depression and was started on paroxetine 20 mg daily.
At her follow up visit, she reported feeling better with
improved sleep and appetite though she still did not feel
enthusiastic about caring for her son. She still reported occasional mild headaches and dizziness. A week later, Ms Y
presented to the medical emergency room with complaints of
severe dizziness and headache. CT scan of head done in
emergency room showed a 4 Â 3 Â 3.5 cm, hyperdense, well
marginated extra axial, right sided parasellar mass (later
confirmed histologically as meningioma) with some surrounding vasogenic edema. MRI confirmed the above finding
and reported the tumor to be located on right sphenoid bone
with some compression of right lateral ventricle. She was
admitted to neurosurgery where she underwent right pterional craniotomy and tumor resection.
Ms Y was discharge after a one week hospital stay. Two
weeks after the discharge, she came for her psychiatry
appointment. She also reported that her paroxetine was stopped
while she was admitted to surgery and she had not resumed the
medication. Ms Y reported resolution of her depressive symptoms after the resection of tumor. She reported good sleep,
appetite, motivation, and good concentration. She also reported
that she now enjoys going out and taking her baby out for walks.
Ms Y was followed on monthly basis in psychiatry clinic
and over the next 3 month. She showed resolution of all her
symptoms of depression. After discussion with the patient,
she was discharged from psychiatry clinic. Ms Y is still
continuing her regular follow up with neurosurgery.
meningioma.6 Temporal lobe meningioma causing postpartum depression has never been reported so far.
The temporal lobe is involved in memory, emotions and
audition.7 Temporal lobe tumors can present similar to frontal
lobe tumors with depressed mood, apathy and irritability or
euphoria and mania. Personality change and anxiety have also
been noted with these tumors of temporal lobe origin.8 Ms Y had
a meningioma located in the temporal lobe which presented
with postpartum depression. Although it is a possibility that her
meningioma and postpartum depression could be unrelated
but it appears unlikely based on her presentation. It is implied
that she had an underlying meningioma which was silent but
during pregnancy this tumor grew and produced psychiatric
symptoms. Many theories have been postulated about accelerated growth of meningiomas in pregnant females9 which
include endogenous hormonal exposure, water retention,
vessel engorgement10 and activation of progesterone receptor.9
Patients presenting in psychiatry emergency room and
outpatient clinics often undergo a medical clearance examination which includes basic lab work including CBC, chem-7,
liver function tests, lipid profile, toxicology screen and a
physical examination. A measurement of weight has also
become routine as many of these patients are prescribed
neuroleptics which are prone to cause metabolic syndrome.
At least 2 studies have suggested that a minimum, basic
screening laboratory studies should be obtained in patients
with no medical complaints presenting for psychiatric evaluation11,12; but the use of neuroimaging to evaluate psychiatric patients has always been a controversial topic of
debate.13 Rosse et al suggested that CT scan of brain would be
indicated in cases with neurological signs, delirium, dementia, anorexia nervosa, and first presentation psychosis. Recommendations were also made regarding patients more than
50 years of age showing personality change or first episode of
depression or mania.14 In this case, the patient was young and
had a recent pregnancy, which coincided with the onset of her
symptoms - routine imaging is less strongly suggested in
these types of patients. Our case had occasional nausea and
headaches which did warrant emergent CT scan but was unfortunately not done. Somatic symptoms like headaches and
nausea can present with depression and thus can be
misleading. Readers are reminded that they should suspect
intracranial pathology as a cause of psychiatric symptoms in
all the patients as the signs and symptoms of an intracranial
mass may be subtle, and a detailed history and physical examination may not reveal early lesions.
This case has reemphasized our need for constant vigilance.
Symptoms that should definitely make a clinician to suspect a
structural cause of psychiatric symptoms include delirium,
disorientation, headaches, recent history of malignancy, and or
focal neurologic symptoms or signs.15 This case also provides
an opportunity for administration to improve and redefine their
departmental protocols and management strategies depending upon the availability of resources and patient population.
3.
Disclosure
Discussion
PubMed search done for literature review reported only one
case of postpartum depression in a patient with bifrontal
Authors of this paper have contributed significantly in this
case report.

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Conflicts of interest
All authors have none to declare.
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