Mental disorders associated with intracranial tumors
Introduction
Introduction to mental disorders associated with intracranial tumors A mental disorder associated with an intracranial tumor refers to an intracranial tumor that invades the brain tissue or cerebral blood vessels of the brain parenchyma, causing damage to the brain parenchyma or increased intracranial pressure. Patients suffering from intracranial tumors have 40% to 100% of people can have mental symptoms. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: non-infectious Complications: epilepsy
Cause
The cause of mental disorders associated with intracranial tumors
The location of the tumor (25%):
The incidence of psychiatric symptoms in temporal lobe tumors is significantly higher than that in other sites. The temporal lobe tumors often have visual and auditory hallucinations. The frontal lobe tumors often show antics and speech. The tumors are located in the left hemisphere or right hemisphere of the brain. has a difference.
Histological type and growth rate of brain tumors (20%):
Rapid growth with increased intracranial pressure often occurs in acute brain organic syndrome; chronically growing tumors are prone to cognitive impairment or local neurological deficits, and cognitive deficits caused by slow growth of tumors are associated with pre-onset intelligence.
Tumor size (15%):
The larger the volume, the more obvious the symptoms.
Pre-disease status (5%):
Brain tumor surgery (5%):
In short, mental disorders caused by brain tumors are related to the combined effects of various factors.
Pathogenesis
1. Forms of psychotic symptoms The forms of mental disorders caused by intracranial tumors can be basically divided into five types: the tumor itself is caused directly or indirectly, the epilepsy caused by the tumor is manifested as a mental episode, and the patient occurs on the tumor and/or surgery. Psychotic reaction; induced schizophrenia, affective disorder, etc. for poor quality, compensation for organic damage.
(1) The tumor itself causes directly or indirectly:
1 The site of tumorigenesis is closely related to mental function, such as temporal lobe, limbic system, corpus callosum, frontal lobe, etc., which are prone to mental symptoms.
2 Tumors due to brain tumor expansion and growth caused by increased intracranial pressure, about 80% of patients with intracranial tumors increased intracranial pressure, causing increased intracranial pressure, including: the tumor occupied a certain space in the cranial cavity, the volume reached or exceeded The limit of the body can be compensated (about 8% to 10% of the volume of the cranial cavity), that is, the intracranial pressure increases, the tumor blocks any part of the cerebrospinal fluid circulation pathway, or the obstructive hydrocephalus is formed due to the tumor obstructing the absorption of cerebrospinal fluid. For example, tumors in the posterior fossa and midline often cause venous sinus reflux obstruction and cerebrospinal fluid circulation pathway obstruction, resulting in accumulation of cerebrospinal fluid, which may cause early symptoms of increased intracranial pressure, brain tumors compress brain tissue, cerebral blood vessels, affect blood supply, Causing metabolic disorders of the brain, or toxic effects of tumors, especially malignant gliomas and metastases, and foreign body reactions, causing local or peripheral brain edema around the brain tumors, tumors compressing large intracranial veins and sinuses Causes intracranial congestion and so on.
These factors affect each other and constitute a vicious circle, which makes the intracranial pressure increase more and more intense. The mental symptoms caused by increased intracranial pressure include neurosis-like symptoms and symptoms of mental excitement or depression.
3 malignant tumors with rapid tumor growth rate, such as softening, necrosis, hemorrhage of pleomorphic glioblastoma itself, necrosis and edema in surrounding tissues, and high invasiveness, easily lead to mental symptoms.
4 The extent of brain tumor associated with cerebral edema, such as brain metastases and rapidly developing malignant tumors, often accompanied by severe brain edema, prone to mental symptoms.
In short, tumors that grow rapidly under normal conditions and are associated with increased intracranial pressure are often characterized by acute brain organic syndrome, while slow-growing tumors are prone to cognitive deficits, directly or indirectly by the tumor itself. Caused, but also affected by the patient's personality.
(2) epileptic seizures caused by tumors are characterized by seizures: seizures are common symptoms of intracranial tumors, accounting for 30% to 40% of patients with intracranial tumors, and episodes of seizures are the first symptoms of intracranial tumors. % (Zhang Xinbao et al., 1986), especially meningioma, astroglioma, pleomorphic glioblastoma, etc., intracranial tumors invading the marginal system of temporal lobe may have a psychotic seizure, that is, psychotic epilepsy The form of seizures, however, is difficult to delineate between them. Intrinsic tumors cause epilepsy, and epilepsy affects mental activity. Whether tumors and epilepsy are related to the development of mental disorders requires further research.
(3) The patient's psychotic response to intracranial tumors and their resection:
1 Mental response to intracranial tumors: This type of response depends on the patient's attitude toward the tumor. Like other psychiatric reactions associated with physical illnesses, patients are too concerned about the prospects of tumors and their treatment, and then develop a mechanism of paralysis. Intention, hostile to medical staff and family members, suspected that they would delay his diagnosis and treatment.
2 transient psychotic reaction after intracranial tumor surgery: 4 cases of patients with mental disorders caused by intracranial tumors in Nanjing neuropsychiatric hospital, 2 cases were postoperative psychiatric reactions, including right parietal meningioma and right frontal lobe 1 meningioma, Xu Minhui (1990) reported 7 cases of transient mental disorders after posterior fossa tumor surgery, including 1 ependymoma, 1 meningioma, 3 acoustic neuromas, 1 epithelioid cyst, pith 1 case of parental tumor, the above two groups occurred within 1 week after surgery, the shortest 2 days, the longest 3 weeks, all cases have no family history of mental illness, clinical excitatory and paranoid symptoms, with nerve blockers It is easy to control, and there is no increase in intracranial pressure during cerebrospinal fluid examination at the time of onset, and it has nothing to do with tumor pathology.
Whether preoperative or postoperative for intracranial tumors, most patients are extremely concerned about brain damage caused by tumors or surgery, and thus cause behavioral responses. This response is similar to disaster response, patient performance is easy to irritate, anxiety and Depression, pre-operative as the tumor grows, there may be perceptual dysfunction, denying the signs of tumors that have been very eye-catching, and the anxiety and depression disappear. This kind of response depends to some extent on the patient's past personality, pre-disease adaptation and The rate of brain damage, the previous adaptation to the environment can predict the severity of the psychological reaction after the tumor, the patient's performance anxiety and depression due to its inability to cope with the intellectual challenges in the environment, when the mental decline continues to progress, the patient's characteristics Sexual reactions are denial, some patients are euphoric, self-feeling, frivolous, meaningless jokes and puns (stupidity witzelsucht).
(4) Intracranial tumor-induced schizophrenia or affective disorder: For those with susceptibility to schizophrenia or affective disorder, intracranial tumors are brain organic diseases that can reduce brain function and induce both types. Mental illness, in addition to genetic influence, as a general rule, any previous brain disease (including schizophrenia) will help to develop another brain disease, such as previous encephalitis, and later prone to schizophrenia. Vice versa, intracranial tumors invade the limbic system, and some cases of schizophrenia-like psychosis have been reported in the frontal lobe, but it remains to be confirmed.
(5) Compensation for organic defects: slow-growing intracranial tumors cause some defects in brain function. As with patients with craniocerebral trauma, patients may compensate for these defects, such as disaster-like reactions at the beginning. Anxiety, depression, and irritability can later lead to behavioral changes in patients with brain trauma.
2. Intracranial tumor pathology and mental symptoms Tumor pathology and mental symptoms are lack of correlation, but the behavioral changes associated with different types of tumors have a certain regularity.
(1) glioma: mainly including astroglioma, pleomorphic glioblastoma, medulloblastoma, Nanjing Neuropsychiatric Institute (1986) 27 cases of intracranial tumor confirmed by surgery or pathological examination Among the patients with mental disorders, gliomas accounted for 59.2%, meningioma 33.3%, and metastatic cancer 7.4%.
1 Astroglioma: Nanjing (1988) 27 cases of intracranial tumors, 16 cases of astroglioma (40.7%), astroglioma occurs in the frontal, parietal and temporal lobe, Generally, it has limited growth, but it can also progress in invasiveness. When such tumors develop to a considerable extent, they begin to have psychiatric symptoms, such as invading the cerebellum of children, and there is no behavioral change. As soon as the ventricular system is blocked, the intracranial pressure is increased and psychotic symptoms begin to appear. .
2 pleomorphic glioblastoma: such tumors occur in the frontal lobe, parietal lobe and occipital lobe, and the rapid development of the tumor tissue and surrounding brain tissue appears in various forms of pathological changes, mental symptoms appear earlier, such Tumor growth is highly invasive, originating from one side of the frontal lobe, quickly affecting the corpus callosum and invading the other frontal lobe, which can cause severe dementia in patients, pleomorphic glioblastoma such as invading the temporal lobe, the spirit Symptoms are obvious. At this time, the visual field is damaged, and the visual field defect can be detected. If the main temporal lobe is damaged, there is aphasia. When the temporal lobe is involved, there is often a seizure attack, sometimes a mental episode, which shows mandatory thinking, hallucinations, and illusions. Mental disorders, automatic symptoms, dream state, automatic reflexes, etc.
3 medulloblastoma: 80% of patients under 15 years old, growing in the midbrain of the cerebellum, may have headache, nausea, vomiting, ataxia, cranial nerve palsy, increased intracranial pressure, etc., a small number of patients with network structure, can be A coma is often misdiagnosed as schizophrenia.
(2) Meningioma: originated from the arachnoid membrane, slow growth, meningioma is a benign tumor, has a capsule formation, is a fibrous structure, occurs in the basal and parasagittal regions of the forebrain, and grows without any clinical Performance or only intelligent decline, meningioma generally does not cause dementia and decreased ability to adapt, because patients can compensate for their deficiencies through defense mechanisms, if the ability to adapt to obstacles, and the size of the tumor, patient needs and pre-disease levels Low related.
These types of tumors cause less intracranial pressure, unless late, meningioma in the parasagittal region, can cause weakness in one or both lower limbs or poor joint movement, easily misdiagnosed as snoring, Patton and Shepherd (1956) It is pointed out that meningioma is the most interesting category of psychiatrists, most of which were not detected before birth, but were discovered after the death of other diseases.
(3) pituitary tumor: pituitary tumor can cause endocrine or visual impairment, close to the third ventricle, difficult to stain pituitary adenoma, craniopharyngioma, ependymoma, pineal tumor can cause obvious mental abnormalities When the tumor oppresses the third ventricle or frontal lobe, the mental symptoms become increasingly severe, the performance is slow, drowsiness, no desire, difficulty in concentration, memory loss, and even euphoria, fiction, if the patient in the drowsiness is awakened, it is easy to provoke Excessive activity and poor judgment, phantoms and delusions can be seen in pituitary tumors.
(4) schwannomas: schwannomas, also known as Schwann cell tumors or schwannomas, in most cases is single, intact capsule, adhesion to the tumor-bearing nerve, more common in the auditory nerve, also seen in the trigeminal Nerve, facial nerve, glossopharyngeal nerve and accessory nerve, the distribution range is the most in the cerebellum pons, and can also occur in the middle cranial fossa, saddle, occipital macropore, accounting for 8% to 12% of all intracranial tumors. Invasion of the auditory nerve causes hearing loss, tinnitus, dizziness, dizziness and other symptoms. As the tumor volume increases, cerebellum and brain stem involvement may occur, and even obstructive hydrocephalus may be formed. Such tumors cause less and mild symptoms of mental symptoms. However, some patients with sphincter tumors may have auditory hallucinations on the side of hearing loss.
(5) metastatic cancer: metastatic cancer accounts for 87% of intracranial malignant tumors. The primary tumor is mostly lung in men, while women are mainly breast cancer. The pathological nature is mostly adenocarcinoma. Metastatic cancer progresses rapidly, from onset. The symptoms are obviously only 3 to 6 months, the incidence of mental symptoms of metastatic cancer is very high, the incidence of psychiatric symptoms of primary intracranial tumors is 1/2, and the incidence of single intracranial metastases is 1/3, multiple intracranial metastases. The cancer is 4/5, and the diffuse metastatic carcinoma of the meninges is 100%. The mental symptoms include nightmares, amnesia, apathy, lack of desire, lack of will, and some patients can see euphoria, stupidity, and metastasis. The patient's memory is reduced, the judgment is reduced, the indifference is unintentional, the consciousness is disordered, the orientation is poor, the drowsiness, and the dementia develops.
3. Factors affecting mental symptoms caused by intracranial tumors
(1) Gender and age: Nanjing (1986) 77 males and 44 females, 33 females, other domestic information (Luo Zhongyu, 1963; Xia Zhenyi, 1963) are more common in women, domestic and foreign data show that 30 to 50 years old More common among young adults, Luo Zhongyu (1963) compared the ages of two groups of intracranial tumors with mental symptoms and no behavioral changes, and found that people with mental symptoms were younger than those without such manifestations.
(2) Sick period: refers to the period of onset to admission, Luo Zhongyu (1963) reported that patients with psychiatric symptoms of intracranial tumors were shorter than those with no behavioral changes, suggesting that mental symptoms are likely to cause attention and early consultation.
(3) Inheritance: The exact cause of intracranial tumors is still unclear. Whether or not the intracranial tumor causes mental symptoms is related to heredity is still under investigation. Patients with intracranial tumors may sometimes have schizophrenia or bipolar disorder. Symptoms, and therefore the patient's pre-disease quality problems cause attention, Bleuler pointed out that the nature of these non-organic psychiatric symptoms can be found in the investigation of family psychiatric history, the family members of brain tumor patients with "intrinsic" mental symptoms, suffering The prevalence of schizophrenia or schizophrenic personality and bipolar disorder is higher than that of the general population. Davison (1986) has a total of 3,000 patients with brain tumors in 8 groups. The prevalence of schizophrenia is 0% to 3.5%. The position and standard error are 1.2%±0.2%, which is higher than the prevalence of schizophrenia in the general population by 0.2% to 0.5%. It is obvious that the concomitant brain tumor and schizophrenia are likely to be larger than expected. Bleulers opinion is Brain tumors themselves do not cause schizophrenia or bipolar disorder, while brain tumors can increase the rate of development of genetic predisposition. Davison believes that brain tumors are likely to cause schizophrenia-like behavior.
(4) Tumor site: Invasion affects the tumors on both sides of the hemisphere and is prone to cause mental symptoms. It is not necessarily caused by the involvement of one side of the hemisphere. The mental symptoms caused by the tumors on the sky and under the canopy may vary depending on the location and the nature of the tumor. Keschner et al. (1937, 1938) reported that 530 cases of brain tumors, 412 cases of psychiatric symptoms, of which 315 cases were on the screen, 61 cases were under the curtain and more late, the mental symptoms were mild and short-lived, they also pointed out that the supratentorial tumor The hallucinations are more common, and the ordinary hallucinations are hallucinations. The opportunities and forms of mental symptoms caused by tumors in the left and right hemispheres have attracted more attention. Some scholars (Kesehner et al., 1938; Gibbs, 1938) reported that the left tumor caused more mental symptoms. However, there is no significant difference in statistical treatment. Bingley (1958) pointed out that in the absence of increased intracranial pressure, intelligence and affective disorders are particularly common in the left temporal lobe, Hou Mingde (1963) of 82 brain tumors, One case was located in the midline of the occipital lobe, and 32.6% of the left side had psychiatric symptoms, while 34.2% of the right side had behavioral changes with no significant difference.
(5) increased intracranial pressure: the relationship between mental symptoms and increased intracranial pressure can not be generalized, should be specifically analyzed, increased intracranial pressure in addition to headache, vomiting and optic disc edema, may have dizziness, confusion, emotional apathy, mental retardation Even coma and other manifestations can be alleviated or disappeared when decompressive surgery or infusion of hypertonic glucose solution. Busch (1967) believes that mental retardation is not associated with increased intracranial pressure, and mental retardation is associated with it. In short, decapitation In addition to the corresponding psychiatric symptoms caused by increased internal pressure, other forms of behavioral changes have nothing to do with increased intracranial pressure.
(6) Mental factors: In addition to personality characteristics and individual qualities, trauma is also a factor that induces mental symptoms in some patients with intracranial tumors. One case of men with right parietal meningioma was isolated before surgery and was caused by tumors. After the symptoms were obvious, he was hospitalized. The patient thought that the diagnosis was delayed and the operation was delayed. As a result, he was suspicious after the operation. When the nurse said that phenytoin sodium was phenytoin, he felt that he had changed the medicine and suspected that there was poison in the rice. The mother-in-law harmed him, and the lovers birth was not good for him. He wanted to jump from the window and was prevented. In fact, any organic mental disorder can reflect pre-symptomatic life events in his mental symptoms, at least in the early stages of the disease. .
Prevention
Prevention of mental disorders associated with intracranial tumors
For patients with confirmed brain tumors, more social, family psychological support and assistance should be given, which is expected to alleviate the symptoms of mental disorders associated with brain tumors.
Complication
Complications of mental disorders associated with intracranial tumors Complications epilepsy cerebral palsy
Local symptoms vary depending on the location and size of the tumor. Cerebral hemisphere tumors close to the central anterior and posterior gyrus may have weak or partial hemiplegia, affecting the language center may have motor or sensory aphasia; saddle area tumor may have primary optic nerve atrophy and vision, visual field changes, tumor affecting pituitary - The lower part of the hypothalamus may have growth and development disorders, obesity or weight loss, polydipsia and hypothermia and thermoregulatory disorders; vestibular tumors often have gait instability, nystagmus, muscle tone and tendon reflexes, and brain stem tumors have cranial nerve damage. And contralateral pyramidal tract signs, pineal tumors have eyeball difficulty and precocious puberty. Often complicated by epilepsy, cerebral palsy and so on.
Symptom
Symptoms of mental disorders associated with intracranial tumors Common symptoms Dementia expression indifferent, lethargy, restlessness, coma, coma, consciousness, confusion, loss of consciousness, slow response, feeling disorder
The clinical manifestations are diverse. Sometimes the symptoms are atypical in the early stage. When the basic features of the tumor are already available, the condition is often advanced. The incidence of brain tumors is slow. The first symptoms are increased intracranial pressure such as headache, vomiting and neurolocalization. Such as muscle weakness, epilepsy, etc., weeks, months or years, symptoms increase, the condition worsens, acute illness can suddenly worsen in a few hours or days, paralyzed, coma, this is more common in tumor cystic changes Tumor hemorrhage (tumor stroke), highly malignant tumor, tumor metastasis, complicated with diffuse acute cerebral edema, or sudden increase in intracranial pressure caused by sudden blockage of cerebrospinal fluid circulation through the tumor (cyst), leading to cerebral palsy and death.
General symptoms
Includes physical symptoms and mental symptoms.
(1) Somatic symptoms: headache, nausea and vomiting, optic disc edema and vision loss are the three main manifestations of increased intracranial pressure caused by brain tumors. As a result of brain tumor expansion, about 80% of patients with intracranial tumors have increased intracranial pressure.
1 headache: start to be seizure, more common in the morning and evening, after the day, the number of headaches increased, the headache part is more in the forehead and ankle, the posterior fossa tumor can have a headache in the posterior occipital region, and radiate to the eyelids, in short, headache With the tumor on the side of the disease, with the development of the disease, headache can be gradually intensified and persistent, coughing, exerting force, sneezing, bowing, headaches are aggravated when emotional, and relieved when lying down.
2 vomiting: more often in the morning or on an empty stomach, vomiting is more common when the headache is severe, most patients with nausea, and sudden vomiting without nausea is not common, patients with severe vomiting can not eat, spit out after eating, The tumor under the curtain is vomiting earlier and more than the on-screen occupancy damage.
3 optic disc edema: optic disc edema early in the curtain and midline tumor, while the tumor slowly growing on the screen appeared later, or even did not occur, optic disc edema mostly bilateral, early no visual impairment, visual field examination showed that the physiological blind spot expanded, the optic disc continued After prolonged edema, the optic nerve atrophy may occur, the optic disc gradually becomes pale, and the vision is reduced, suggesting that the optic nerve has secondary atrophy and even blindness.
About one-third of patients with brain tumors often have seizures, and intracranial pressure may also have convulsions. Poor balance in standing position, tenderness in the trigeminal nerve distribution area, nerve palsy, diplopia, dizziness, tripping, etc. In acute or subacute cases, there may be pulse, blood pressure and respiratory changes. The pulse can be slowed down to between 50 and 60 beats per minute. The breathing slows and becomes deeper. When the intracranial pressure continues to increase, the pulse can increase. Fast and irregular.
(2) Psychiatric symptoms: The general psychiatric symptoms of intracranial tumors include confusion, amnesia syndrome, dementia, and less common sputum-like and schizophrenia-like psychosis.
1 confusion: confusion is a general symptom of brain tumors, can be expressed in different forms and variability, can be seen in any part of the rapid development of tumors, is an acute brain organic syndrome, Bleuler (1951) reported 37% of cases Conscious ambiguity, but usually not serious, clinically difficult to understand and respond, slow, slow response, sluggish, lethargy, inattention, apathy, disorientation, colloidal cysts in the third ventricle, due to intermittent appearance Hydrocephalus, disturbance of consciousness can be volatility, sometimes the patient can suddenly return to normal, and sometimes quickly into the paralyzed state, when the intracranial pressure is significantly increased, the state of consciousness can rapidly deteriorate, which is due to the occurrence of hookback, Ambiguity is not entirely caused by increased intracranial pressure, and confusion or coma can occur as the brain stem and inter-brain tumors damage the reticular formation.
2 amnesia syndrome: Bleuler (1951) data show that amnesia syndrome accounts for 38% of brain tumor cases, is the result of diffuse brain damage, which is common in slow-growing cases of intracranial tumors (Gelder et al, 1983), but localized lesions near the bottom of the brain and the third ventricle can also be caused. When the intracranial pressure is increased, the amnesia syndrome has no localization value. If there is no increase in intracranial pressure, it indicates that there is a tumor at the base of the skull. The performance of recent memory loss or forgetting, the memory of past experience can not be reproduced, and even the new memory is distorted, but the general memory can be relatively good, the development of the disease can be oriented disorder, antegrade forgetting and accompanied by fiction In Sakov syndrome, patients are often indifferent to memory defects.
3 Dementia: Patients with slow-growing and long-term brain tumors can express dementia, which is a defect in calculation, understanding and judgment. This symptom can be found in time because it cannot adapt to work, and the polymorphism of rapid infiltration growth Glioblastoma can also cause mental decline shortly after onset. Sachs (1950) pointed out that meningioma can cause dementia, especially in elderly patients with brain tumors, especially for any rapidly developing dementia, especially with the patient's physical condition. When disproportionate, the existence of brain tumors should be suspected. The increase of intracranial pressure in middle-aged and elderly patients may lead to amnesia syndrome in the early stage. The late stage is often dementia. It may be slow in thinking, lack of thinking content, empty, inconsistent statement, behavior. Disorderly and peculiar, incomprehensible and intelligent.
Case: Male, 19 years old, unmarried, worker, usually with excellent work performance, the unit intends to mention it as a cadre, but the self-satisfaction at the time of assessment is contrary to leadership, sleepiness after illness, work efficiency decline, daze, staying in bed on the third day From the beginning, life needs people to cook, the eyes are closed, the orientation is poor, the memory is diminished, and soon after the development to the urine and the stool can not take care of themselves, the situation is getting worse, died on the 12th day after hospitalization, the autopsy found a huge skin sample of the left temporal lobe Cyst, the tumor originated from the indoor side of the left cerebral side, filled the entire left side of the left side of the chamber, the left brain volume expanded, the cause of death was the formation of hippocampus on both sides.
4 schizophrenia-like psychosis: intracranial tumors can induce schizophrenia, but the two may be more likely than expected, indicating that there may be special parts of brain tumors can cause schizophrenia-like psychosis, such cases clinical and schizophrenic The symptoms are similar, but the course of the disease is short. The content of the delusion is not absurd. There are more hallucinations in the hallucinations. There are also hallucinations, illusions and hallucinations. Sometimes it can be seen that allergies or disappearances and perceptual barriers are common. Behavioral anomalies occur simultaneously.
Case: Male, 38 years old, married, worker, started headache 2 years ago, was in the forehead and left ankle, showing twitching pain, improved after rest, nausea and vomiting and nighttime convulsion after 1 year, headache gradually worsened, unresponsive Apathy, mental retardation, slow calculation, shallow left nasal canal, stretched left tongue, ultrasound examination showed midline deviation, surgery confirmed as frontal meningiomas, patients were suspicious after surgery, suspected surgeons and The lover has an abnormal relationship. The doctor, the unit comrade and the lover collude to harm him. He thinks that the meal is poisonous and refuses to eat. The doctor gave him a lot of inexplicable injections to harm him. He took chlorpromazine, perphenazine and other drugs. On the 8th day after the operation, he attempted suicide by jumping off the building, causing the splitting of the head and the rupture of the spleen. After the surgical rescue and recovery, the mental symptoms still did not improve. He believed that the surgeon had to marry his lover and occasionally had impulsiveness due to management difficulties. Transferred to the psychiatric department, after a few thoughts to dissipate, I feel strange to people, to apologize to the surgeon.
5 affective disorders: intracranial tumors with less emotional disorders, generally more common feelings of indifference, depression, mostly indifferent to outside things, look sluggish, lack of initiative. It can also be seen without reason, crying, emotional instability, irritability, depression, easy to cry, irritability, anxiety; especially the temporal lobe tumor, intracranial tumors and manic episodes are rare, and patients with frontal lobe tumors are naive. Occasionally euphoric symptoms.
Case: Male, 52 years old, married, cadre, admitted to hospital with repeated episodes of mental disorder in 10 years. Insomnia, dizziness, depression, rest at home in 1980, due to previous (1976) gastric surgery diagnosis of gastric cancer in situ, this I was also worried about whether I had brain cancer. I was excluded from the head CT examination. In 1981, my wife went out to play cards and my daughter was dissatisfied with her boyfriend. The performance was irritating. She once suspected her wife. Her daughter was not good at herself and was relieved by outpatient medication. In 1983, the drug was re-issued, and the performance was the same as before. After treatment, there was a slight attack in March 1985. The performance was irritating, and it was quickly controlled after taking the drug. In 1986, there was paroxysmal right convulsion and right ear hearing loss. In 1988, due to the onset of drug withdrawal, there was a lot of excitement, squandering, squandering everywhere, visiting teachers and students who had not been in contact for many years. For the 50th birthday, please be a guest, feel smart and capable, routinely review the head CT and find the right There is a low-density space-occupying lesion in the posterior fossa of the lateral cerebellar pons, and the possibility of intracranial epidermoid tumor is large. The psychotic symptoms are controlled again. Mild disease fluctuations occurred in 1988 and 1989. But most of the time is normal, and it was issued again in 1991. It shows insomnia, more excitement, chaos buying food, nostalgia, constant visits to friends, love to express opinions, and boasting of their talents. The CT review still shows the original lesions. There was no obvious change in morphology, location, size and density. This case is an emotional disorder associated with intracranial tumors, which may induce the recurrence of the former.
6 Psychotic reactions based on the cause of the heart: whether the patient's psychotic reaction to the attitude of the intracranial tumor, or the post-operative transient psychotic reaction has a psychogenic basis, and the patient's pre-personal personality Related to the non-specific compensation behavior of organic defects, found in brain damage and other brain organic diseases, see the chapter on mental disorders associated with craniocerebral injury.
7 personality changes and abnormal behavior of patients with lack of initiative, reduced interest, lazy life, passive behavior, do not know clean, lack of shame, do not take the initiative to eat, staying or bedridden all day long, silent, even similar to stiff; Or shouting, running around, or collecting stolen goods, personality changes, behavioral abnormalities and intelligent changes often occur simultaneously.
2. Localized diagnosis of localized tumors must be combined with the localized symptoms of the nervous system to analyze, in order to make a correct judgment, the appearance of mental symptoms, different manifestations due to different parts of the tumor invasion, various parts The localization symptoms of brain tumors have their own characteristics, which can be judged according to the neuroanatomical structure and physiological functions of the site.
(1) Frontal lobe: The frontal lobe is located in front of the central sulcus, above the lateral fissure, the lateral aspect and the bottom surface of the frontal lobe are supplied by the middle cerebral artery, and the inner side is derived from the anterior cerebral artery. The frontal lobe tumor can present three obstacles, namely, random Exercise, language expression and spiritual activity.
1 random movement: the frontal lobes effervescent through the pons to the contralateral cerebellar hemisphere, the mutual movement of the free movement, the frontal tumor of the frontal lobe can cause contralateral limb ataxia symptoms, but no nystagmus, central anterior gyrus When the tumor occurs in the area, it can cause focal sports epilepsy, the consciousness is not lost during the attack, and the facial muscles or fingers have clonic convulsions.
2 language expression: the left frontal gyrus area lesions produce motor or expression aphasia.
3 mental activities: mainly manifested mental retardation, indifferent expression, memory, attention, understanding and judgment, decreased thinking and comprehensive ability, not pay attention to neatness, do not know the urine, sometimes strong grip and groping reflection, the main hemisphere is subject to Loss can be aphasia.
A. Personality change: The behavior of patients with frontal lobe tumors becomes indulgent and clumsy, emotionally euphoric, childish, and stupid, and the frontal tumor patients are characterized by the simultaneous presence of opposite emotions and will activities, such as euphoria and Apathy and indifference, love to joke and indifference to the surrounding, irresponsible, irritating and lack of self-control are also common changes.
B. Apathetic-akinetic-abulic syndrome: This syndrome can occur in anterior lobes, especially bilateral lesions. The patient is apathetic and lacks interest in the surroundings. Do not pay attention to the neat, slow, careless, imaginative and thinking ability, lack of initiative, memory and mental decline, slow action, facial expression confused, staying wood.
C. Stupor: When the frontal lobe tumor grows rapidly, the stupor is observed. The patient is inactive for a long time, silent or not, and may even have obstacles in urinary control.
The above-mentioned frontal lobe syndrome is not specific, and the clinical findings can also be seen in cases of temporal lobe tumors, and the hook-back episodes caused by temporal lobe lesions are also seen in frontal lobe tumors.
(2) corpus callosum: surgical removal of the corpus callosum does not produce any symptoms, and the serious mental symptoms caused by corpus callosum tumors are more common than other parts, mainly due to the damage of the adjacent frontal and midbrain, the midbrain, and the tumor of the corpus callosum 92% had psychiatric symptoms, 57% in the middle and 89% in the pressure (Schlesinger, 1950). Selescki (1964) also thought that the anterior and posterior parts were more common. The anterior tumor of the corpus callosum did not show signs of nervous system, headache and intracranial Significant mental decline has occurred before the increase in pressure (Lishman, 1978). Clinically, there may be affective disorders and mental defects. The anterior and middle third of the corpus callosum may have speech disorders such as poor speech, imitating speech, and speech. In the absence of understanding ability, the posterior part of the corpus callosum is often accompanied by memory and disorientation, and the recognition of surrounding things is also difficult. Because the tumor easily damages adjacent brain tissue, such as the third ventricle, the diencephalon and the cingulate bundle, Therefore, it can be accompanied by a richer mental symptoms. When the corpus callosum is caused by a personality disorder similar to that of the frontal lobe, it can be seen that the sleepy part of the brain is visible, lethargic and exercise can not be blamed. The abnormal movements pose similar catatonia.
(3) temporal lobe: the psychiatric symptoms of the temporal lobe tumor are striking, and there are many increased intracranial pressure, visual field defects, sensory aphasia, epilepsy, mental autonomic disorder, hallucinations, deep lesions may appear contralateral unilateral hemianopia or 1/ 4 visual field defect, the main side hemisphere lesions may appear sensory aphasia, because the temporal lobe and the frontal lobe are adjacent and have close fiber contact, so the tumor may have some frontal lobe symptoms, such as personality changes, no desire - exercise can not - lack of will Syndrome, stupor, etc., tumors confined to temporal lobe can have two forms of mental disorders, including behavioral and emotional changes in the onset of seizures and seizures.
1 hook back episode: the beginning of the attack often begins with the illusion and illusion, suddenly smells or tastes stench or strange smell, some may be accompanied by mild dizziness, followed by a confused and dream-like state called hook-back episode, When the patient is unreal, such as deja vu or old things, the object is large or small, the surrounding sound is particularly loud, the perception of space and time has also changed, and the near-object is far away, and the time is like a movie-like lens. After a long period of experience, there may be a feeling of discomfort in the upper abdomen, accompanied by fear. The illusion may be primitive, seeing the light, but the complex illusion with dreams is common, and the auditory hallucinations are rare, often with other Formal illusions are intertwined to form a compound nightmare-like experience. When the attack occurs, the mouth can be automatically moved, such as chewing, licking lips, and tasting the movement.
2 automatic symptoms: automatic symptoms are also common, mostly in the evening, the form of automatic symptoms is diverse, more persistent for a short time, after forgetting, patients can only have simple movements, such as indoors without purpose, finishing clothes, moving Something, sometimes more complex behaviors can occur, such as roaming out, as a specific patient, each auto-sickness episode is the same.
3 seizure behavior and mood changes: personality changes in temporal lobe tumors are not specific, similar to the frontal lobe tumors as described above, Strobos (1953) found that 11% of patients with temporal lobe tumors have a tendency to pathological personality and paranoia Focus on your health and irritability. The original personality characteristics of the temporal lobe tumor are highlighted, or the form of pre-existing personality response to tumor or seizure.
Emotional performance is unstable, irritating and aggressive, often with violent emotions and violent behaviors. Some patients with temporal lobe tumors have anxiety, depression and poor mood, and need to be distinguished from depression.
It is not uncommon for people with schizophrenia-like psychosis to occur during the interictal period. This type of mental disorder is most common in temporal lobe tumors, and secondly in pituitary tumors (Lishman, 1978). It may be that such cases have tumors that promote or induce genetic quality of schizophrenia. The disease may occur, and others may be directly caused by temporal lobe lesions.
(4) parietal lobe: parietal tumor caused by less psychiatric symptoms than frontal lobe or temporal lobe tumor, easily lead to cognitive dysfunction, mainly sensory disturbance, often with sensory epilepsy, contralateral limb, trunk sensation (including cortical sensation Decreased, paroxysmal paresthesia, disuse, etc., major hemispheric lesions may have loss of reading, loss of writing, miscalculation and autism of autologous parts, etc., because the parietal lesions cause early signs of exercise and sensation, less misdiagnosed as Psychiatric diseases, topal lobe tumors can occur with high-level sensory comprehensive functional defects, patients with many complex cognitive activity disorders, bilateral parietal lesions can cause visual space judgment difficulties and terrain orientation disorders.
The formation of body image is the result of the afferent information of the parietal cortex through the proprioceptor. Therefore, patients with parietal tumors may have various body image disorders, such as unilateral unawareness or neglect, and half body recognition. (hemisomatognosis), anosognosis, autotopagnosia, reduplication phenomenon, amorphosynthesis, etc., the patient's sense of touch and pain are not impaired, but cannot be touched To identify the object, that is, the physical sensory disorder (astereognosis), can not say what the word or figure of the palm of the hand is, said that the sense of writing loss, when the posterior parietal tumor affects the occipital lobe, the appearance of aphasia.
Patients with parietal lobe tumors may have depression, and personality disorders are less common. Such patients may not properly pay attention to the left and right of their own body and surrounding things (such as clothes). Patients may have clothing defects and difficulties, called dressing loss. Dressing apraxia can sometimes lead to misdiagnosis as dementia or snoring.
(5) occipital lobe: occipital lobe tumors are relatively rare, which cause mental symptoms mainly manifest as visual obstacles. The most common visual hallucinations are phantoms. In addition to causing visual field defects, there are no clear localized symptoms, and clinical contralateral eccentricity is produced. The main hemisphere lesions may have visual agnosia, that is, the objects and colors seen are not recognized, while the parietal and posterior temporal lobe lesions only have contralateral lower 1/4 or upper 1/4 visual field defects, such as pillows. Leaf irritation lesions can be seen in primitive visual hallucinations. When the occipital lobe tumors involve the parietal lobe and temporal lobe, a complex visual illusion occurs. Because the tumor causes an increase in intracranial pressure earlier, there may be corresponding mental symptoms.
(6) Diencephalon: The tumor can damage the thalamus, the lower thalamus and its adjacent third ventricle, which can express metabolic disorders, endocrine disorders, autonomic dysfunction, neuropsychiatric disorders, etc., showing more significant mental symptoms, such as obvious Memory impairment, intelligent decline, personality changes mainly include: irritability, allergies, impulsiveness, excitement, irresponsibility for work, carelessness, carelessness, childishness, stupidity and personal habits.
1 memory disorder: 14% of tumors involving the third ventricle have memory defects (Williams and Pennybacker, 1954), and some manifest as amnesia-fiction syndrome, invading the mesencephalic and third ventricle of the craniopharyngioma, such as excluding the skull A special memory disorder can also be found by the influence of increased internal pressure.
2 dementia: due to chronic obstruction of cerebrospinal fluid circulation can cause cortical atrophy, the brain tumor can have dementia performance, especially in middle-aged and elderly patients.
3 Personality changes: inter-brain tumors can be seen similar to personality changes in frontal lobe syndrome, such as reduced initiative, naive behavior, stupid humor, etc., but different from frontal lobe lesions, patients with malignant brain lesions are not aware of damage.
4 paroxysmal or periodic mental disorders: lesions in the interbrain can cause paroxysmal or periodic behavior changes, patients with high mood volatility, sometimes depression and emotional ups, or emotional control ability reduced by turmoil, limited to Tumors of the brain can be seen with no intentional excitement and stasis in the onset of mental illness. Each phase lasts for 1 to 2 weeks. Patients with a third ventricle-like cyst can have sudden onset and sudden stop of headache, paralysis or confusion.
5 lethargy - bulimia: inter-brain tumors often cause drowsiness and excessive sleep, but can wake up, some appetite increases, there is a diagnostic value of localization.
(7) Tumors under the sky: There are fewer psychiatric symptoms in the under-the-skin tumor, and most of them appear in the late stage of the disease. These include cerebellum, cerebellar pons, pons and medullary tumors, ie, posterior fossa tumors, cerebellum and cerebellar pons The clinical manifestations have been described in medulloblastoma and schwannomas. The pons and medulla are located in the lower part of the brainstem. If new organisms grow, there may be paroxysmal silence, memory loss, slow thinking, emotional instability and confusion to consciousness. Loss, regardless of increased intracranial pressure, the episode lasted for a short period of time, only 3 to 10 minutes, accompanied by heart rhythm, respiration, blood pressure, skin color, muscle tension changes in the limbs, patients with posterior fossa tumors are prone to transient spirit before and after surgery Obstacles, when they are conscious, are mainly manifested as depression or paranoid psychosis.
(8) Central area: can express irritation symptoms, localized seizures of the contralateral limbs, and can also develop systemic seizures.
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