Astrocytoma with clinical features of complex focal seizures and post-operative psychosis

Abstract

Case report of a patient with Astrocytoma in parahippocampal region of the left hemisphere who developed schizophreniform psychosis after resection of the left temporal lobe. Mental and neurological status; Scale for positive and negative schizophrenic syndrome (PASS) assessment; MINI (Mini international neuropsychiatric interview, version 4.4; N subcategory for psychotic contents; Scheehan Disability Scale (SDS); Hamilton Depression Rating Scale; Montgomery-Asberg Depression Rating Scale; EEG; standard and upon sleep deprivation registration; CT and NMR scans of endocranium. A female patient 51 years old has had epileptic seizures since the age of 12; the seizures were defined as simple and complex focal in a form of fixed gaze, motor and ambulatory automatisms with rare secondary generalization, and postictal confusion. After having a NMR scan of endocranium determining a tumour in the left parahippocampal formation, a resection of left temporal lobe was performed identifying a grade II Astrocytoma. After the intervention, a development of polymorph symptomatology occurred with domination of paranoid-depressive syndromes and epileptic seizures with aura consisted of feeling of fear, spatio-temporal disorientation and loss of consciousness. The patient was treated with rational antiepileptic polytherapy and neuroleptics resulting in clinical improvement of psychosis features and decrease of the epileptic seizures frequency. The development of 'de novo psychosis' with clinical features of schizophreniform epileptic psychosis coincided with the temporal lobectomy.

Keywords

• postoperative psychosis
• Astrocytoma
• temporal lobectomy
• schizophreniform psychosis