Disordered and peculiar behavior
Introduction
Introduction Behavioral disorders and peculiarity are one of the clinical manifestations of 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. The types of brain tumors encountered by psychiatrists are different from those of neurology. The former is arranged in the order of appearance as meningiomas, gliomas, metastases and pituitary tumors. The order of neurology is glioma, meningiomas, pituitary tumors and metastases. Therefore, psychiatrists should pay more attention to meningioma, glioma and metastatic cancer. Detailed neurological examination is an important factor in preventing misdiagnosis, but it is often ignored by clinical psychiatrists. In the short-term development of severe mental decline or dementia, more common in metastatic cancer and pleomorphic glioblastoma, in addition to EEG, CT, MRI and other tests to confirm, the need to take chest radiographs for metastatic cancer to find the original Stove.
Cause
Cause
(1) Causes of the disease
Certain characteristic symptoms of mental disorders caused by brain tumors are closely related to the following aspects.
1. Tumor site: The incidence of mental symptoms in frontal and temporal lobe tumors is significantly higher than that in other sites. The temporal lobe tumor often has visual and auditory hallucinations, and the frontal lobe tumor often shows antics and speech. There are also differences in the effects of tumors on the left or right hemisphere of the brain on mental symptoms.
2. Histological types and growth rate of brain tumors: Rapid growth with increased intracranial pressure often occurs in acute brain organic syndrome, chronically growing tumors are prone to cognitive impairment or local neurological deficit symptoms, resulting from slow growth of tumors Cognitive deficits are related to intelligence before onset.
3. Tumor size: The larger the volume, the more obvious the symptoms.
4. Functional status before the illness.
5. Brain tumor surgery.
In short, mental disorders caused by brain tumors are related to the combined effects of various factors.
(two) pathogenesis
1. Form of mental symptoms: The forms of mental disorders caused by intracranial tumors can be basically divided into five types. The tumor itself is directly or indirectly caused; the epilepsy caused by the tumor is manifested as a mental episode; the patient's psychotic reaction to the tumor and/or surgery; the schizophrenia is induced to the poor quality; the affective disorder; Compensation for damage.
(1) The tumor itself causes directly or indirectly:
1 The site of tumorigenesis is closely related to mental function. Such as sacral leaves, limbic system, corpus callosum, frontal lobe, etc., 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 have increased intracranial pressure. The causes of increased intracranial pressure include: the tumor occupies a certain space in the cranial cavity, and the volume reaches or exceeds the limit that the body can compensate (about 8% to 10% of the volume of the cranial cavity), that is, the intracranial pressure increases; the tumor is blocked. Obstructive hydrocephalus is formed in any part of the cerebrospinal fluid circulation pathway, or because the tumor interferes with 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 oppress 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 brain tumors; tumor compression of intracranial large 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. Psychiatric symptoms caused by increased intracranial pressure include a group of neurotic symptoms and a group of symptoms characterized by mental excitement or depression.
3 malignant tumors with rapid tumor growth rate, such as softening, necrosis and hemorrhage of pleomorphic glioblastoma itself, necrosis and edema in surrounding tissues, and high invasiveness, easily lead to mental symptoms.
4 degree of brain tumor associated with cerebral edema. For example, brain metastases and rapidly developing malignant tumors are often accompanied by severe brain edema, which is 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. Although this type of mental disorder is caused directly or indirectly by the tumor itself, it is also affected by the patient's personality.
(2) epileptic seizures caused by tumors: seizures are common symptoms of intracranial tumors, accounting for 30% to 40% of patients with intracranial tumors. Epileptic seizures accounted for 10.3% of the first symptoms of intracranial tumors (Zhang Xinbao et al., 1986), especially meningioma, astroglioma, pleomorphic glioblastoma, and the like. Intracranial tumors can be found in the limbic system of the temporal lobe, which is a form of seizure of psychotic epilepsy. However, the boundary between them is difficult to delineate. 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 psychotic reactions associated with physical illnesses, patients are too concerned about the prospects of cancer and its treatment, and then develop a mechanism of paranoia that is biased, hostile to health care workers and their families, and suspect that they are associated with delaying 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 each. 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, and 1 medulloblastoma. The above two groups occurred within 1 week after surgery, the shortest 2 days, the longest 3 weeks. All cases had no family history of psychosis, and the clinical symptoms were mainly excitatory and paranoid, and it was easy to control with nerve blockers. There was no increase in intracranial pressure during cerebrospinal fluid examination at the time of onset, and it was not associated with tumor pathology.
Whether preoperative or postoperative for intracranial tumors, most patients are extremely concerned about the destruction of brain function in tumors or surgery, and thus cause behavioral responses. This response is similar to a catastrophic response, and the patient's performance is prone to irritability, anxiety and depression. Perceptual dysfunction can occur as the tumor grows preoperatively, denying those signs that are already very visible, and anxiety and depression disappear. This type 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 response to the tumor. Patients exhibit anxiety and depression because they are unable to cope with intellectual challenges in the environment. When the mental decline continues to progress, the patient's characteristic response is denied, and 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 influences, as a general rule, any previous brain disease (including schizophrenia) may contribute to the subsequent occurrence of another brain disease, such as previous encephalitis, and later schizophrenia, and vice versa. . Intracranial tumors have invaded 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. In the Nanjing Neuropsychiatric Hospital (1986), 27 patients with mental disorders caused by intracranial tumors confirmed by surgery or pathological examination, glioma accounted for 59.2%, meningioma 33.3%, 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, It is generally limited in growth, but it can also progress invasively. Psychiatric symptoms begin when such tumors develop to a considerable extent. If the child's cerebellum is invaded, there is no behavioral change. As soon as the ventricular system is blocked, the intracranial pressure is increased and the mental symptoms begin to appear.
2 pleomorphic glioblastoma: These tumors occur in the frontal lobe, parietal lobe and occipital lobe. The rapid development of the tumor tissue and surrounding brain tissue has various forms of pathological changes, and mental symptoms appear earlier. Such tumor growth is highly invasive, originating in one side of the frontal lobe, quickly affecting the corpus callosum and invading the other frontal lobe, which can cause severe dementia to the patient. If the pleomorphic glioblastoma invades the temporal lobe, the mental 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, showing mandatory thinking, hallucinations, illusions, mood disorders, autonomic symptoms, dream-like state, and automatic oral reflex.
3 medulloblastoma: 80% of patients under 15 years old, growing in the midline of the cerebellum, may have headache, nausea, vomiting, ataxia, cranial nerve palsy, increased intracranial pressure. A small number of patients with reticular formation can be seen with coma, often misdiagnosed as schizophrenia.
(2) Meningioma: originated from the arachnoid membrane and grows slowly. Meningioma is a benign tumor with a capsule formation and a fibrous structure that occurs in the basal and parasagittal regions of the forebrain. It grows large without any clinical manifestations or only intelligent decline. Meningioma generally does not cause dementia and decreased adaptive capacity, because patients can compensate for their deficiencies through defense mechanisms. If the adaptive capacity is impaired, it is mostly related to the size of the tumor, the patient's needs and the low level of pre-treatment.
These tumors cause less intracranial pressure, unless late. Meningioma located in the parasagittal region can cause weakness in one or both lower limbs or poor joint movement, which is easily misdiagnosed as snoring. Patton and Shepherd (1956) 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. Difficult to stain pituitary adenoma close to the third ventricle, craniopharyngioma, ependymoma, pineal tumor can cause obvious mental abnormality, when the tumor oppresses the third ventricle or frontal lobe, the mental symptoms become increasingly serious, and the performance is slow , lethargy, no desire, difficulty in concentration, memory loss, and even euphoria, fiction. If the patient in the drowsiness state is awakened, it is easy to be irritated, too active and poorly judged. Hallucinal tumors can be seen in hallucinations and delusions.
(4) schwannomas: schwannomas, also known as Schwann cell tumors or schwannomas, in most cases is single, complete capsule, and adhesion to the tumor-bearing nerve. More common in the auditory nerve, can also be seen in the trigeminal nerve, facial nerve, glossopharyngeal nerve and accessory nerve, the distribution range is the most in the cerebellum pons, can also occur in the middle cranial fossa, saddle, occipital large hole area, accounting for all intracranial tumors 8% to 12%. Early violation 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 form. Such tumors cause fewer and milder psychiatric symptoms, but some patients with auditory schwannomas may experience 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, and the pathological nature is mostly adenocarcinoma. Metastatic cancer progresses rapidly, from onset to symptoms, which are only 3 to 6 months. The incidence of psychiatric symptoms of metastatic cancer is very high. The incidence of psychiatric symptoms of primary intracranial tumors is 1/2, that of single intracranial metastases is 1/3, and that of multiple intracranial metastases is 4/5, and diffuse meningeal Metastatic cancer is 100%. Psychiatric symptoms include nightmares, amnesia, apathy, lack of desire, and lack of will. Some patients can see euphoria and stupidity. In the late stage of metastatic cancer, the patient's memory is reduced, the judgment is reduced, indifferent, unconscious, confused, poorly oriented, lethargic, dementia develops.
3. Factors affecting mental symptoms caused by intracranial tumors:
(1) Gender and age: In Nanjing (1986), there were 44 males and 33 females in 77 cases. Other domestic information (Luo Zhongyu, 1963; Xia Zhenyi, 1963) was more common in women. Domestic and foreign data show that young people aged 30 to 50 are more common. Luo Zhongyu (1963) compared the ages of two groups of intracranial tumors with psychotic symptoms and no behavioral changes, and found that those with psychiatric symptoms were younger than those without such manifestations.
(2) Sick period: refers to the onset of illness until admission. Luo Zhongyu (1963) reported that patients with psychiatric symptoms of intracranial tumors had shorter disease duration than those without behavioral changes, suggesting that psychiatric symptoms are likely to cause attention and early consultation.
(3) Inheritance: The exact cause of intracranial tumors is still unknown. Whether or not the intracranial tumor causes mental symptoms is related to heredity is still under investigation. Because patients with intracranial tumors sometimes have symptoms similar to schizophrenia or bipolar disorder, 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. Among the families of patients with brain tumors with "intrinsic" mental symptoms, the prevalence of schizophrenia or schizophrenic personality and bipolar disorder is higher than that of the general population. Davison (1986) combined 8 groups of 3,000 patients with brain tumors, the prevalence of schizophrenia was 0% to 3.5%, and the median and standard error was 1.2% ± 0.2%, higher than the general population of schizophrenia. The rate is 0.2% to 0.5%, and it is clear that the concomitant brain tumor and schizophrenia are likely to be larger than expected. Bleuler's insight is that brain tumors themselves do not cause schizophrenia or bipolar disorder, while brain tumors increase the rate of development of genetic predisposition; Davison believes that brain tumors are likely to cause schizophrenia-like manifestations.
(4) Tumor site: Infiltrates affecting the tumors on both sides of the hemisphere are prone to cause mental symptoms, which may not be caused when one hemisphere is involved. The mental symptoms caused by tumors on the sky and under the sky can vary depending on the location and 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 on-the-spot tumor illusion is more common, and it is usually an auditory hallucination. 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 psychiatric symptoms, but there was no significant difference between the statistical treatments. Bingley (1958) pointed out that in the absence of increased intracranial pressure, intelligence and affective disorders are particularly common in the left temporal lobe. Among the 82 brain tumors of Hou Mingde (1963), 1 was located in the midline of the occipital lobe, 32.6% of the left side had psychiatric symptoms, and 34.2% of the right side showed behavioral changes, and there was no significant difference.
(5) increased intracranial pressure: the relationship between mental symptoms and increased intracranial pressure can not be generalized, should be specifically analyzed. In addition to causing headache, vomiting and optic disc edema, increased intracranial pressure may have dizziness, confusion, emotional apathy, mental retardation and even coma, which can be alleviated or eliminated when decompressive surgery or infusion of hypertonic glucose solution. Busch (1967) argues that mental retardation has nothing to do with increased intracranial pressure, and that mental retardation is associated with it. In short, except for the increase in intracranial pressure caused by the corresponding mental symptoms, other forms of behavioral changes have nothing to do with increased intracranial pressure.
(6) Mental factors: In addition to personality traits and individual qualities, trauma is also a factor that induces mental symptoms in patients with intracranial tumors. A case of male right parietal meningiomas was isolated before surgery and hospitalized when the symptoms caused by the tumor were obvious. The patient thought that the diagnosis was delayed, the operation was delayed, and the suspiciousness occurred after the operation. When the nurse said that phenytoin sodium was phenytoin sodium, he felt that he had changed the medicine, and then he suspected that there was poison in the rice, and he suspected that the mother-in-law had harmed him. Poor birth is not good for him, and it is intended to be prevented from jumping from the window. In fact, any organic mental disorder can reflect pre-hospital life events in its psychiatric symptoms, at least in the early stages of the disease.
Examine
an examination
Related inspection
Brain ultrasound examination of brain CT
Clinical manifestations are diverse. Sometimes the symptoms are atypical in the early stage, and when the basic features of the tumor are already available, the condition is often late. The incidence of brain tumors is slow. The first symptoms are increased intracranial pressure such as headache, vomiting and neurological localization symptoms such as muscle weakness, epilepsy and so on. After weeks, months or years, the symptoms increase and the condition worsens. In acute cases, the condition may suddenly deteriorate in a few hours or days, and it may be paralyzed or comatose. This is more common in cystic changes of the tumor, tumor hemorrhage (tumor stroke), highly malignant tumors, tumor metastasis, and diffuse acute brain edema, or The intracranial pressure is rapidly increased due to sudden blockage of the cerebrospinal fluid circulation pathway by the tumor (cyst), leading to cerebral palsy and death.
1. General symptoms include 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. Increased intracranial pressure occurs in approximately 80% of patients with intracranial tumors due to brain tumor expansion.
1 headache: began to be seizure, more common in the morning and evening, after which the number of headaches increased during the day. The headache area is mostly in the forehead and ankle, and the posterior fossa tumor can cause headache in the posterior occipital region and radiate to the eyelid. In short, the headache is prominent on the side of the tumor. As the disease progresses, the headache can be gradually intensified and persistent. Cough, exertion, sneezing, bowing, headache, and headache are aggravated, and it is 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 are accompanied by nausea, and sudden ejection vomiting that is nausea is not common. Patients with severe vomiting cannot eat, and 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 off-screen and midline tumors, while the tumor slowly growing on the screen appeared later, or even did not occur. Most of the optic disc edema was bilateral, with no visual disturbance in the early stage, and visual field examination showed an increase in physiological blind spots. After the optic disc continues to edema for a long time, it can be secondary to optic atrophy, the optic disc is gradually pale, vision loss, suggesting that the optic nerve has secondary atrophy, and even blindness.
Approximately one-third of patients with brain tumors often develop seizures. Increased intracranial pressure may also have convulsions, poor balance in standing position, tenderness in the trigeminal nerve distribution area, nerve palsy, diplopia, dizziness, tripping and so on. In acute or subacute cases, there are still pulse, blood pressure and respiratory changes. The pulse can be slowed down to between 50 and 60 beats per minute, and the breathing slows and becomes deeper. When the intracranial pressure continues to increase, the pulse can be increased 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 that 37% of cases were ambiguous, but usually not serious. Clinically understandable and difficult to understand, slow, slow, sluggish, lethargy, inattention, apathy, disorientation. When a gelatinous cyst occurs in the third ventricle, the disturbance of consciousness may be fluctuating due to intermittent hydrocephalus. Sometimes the patient may suddenly return to normal, and sometimes it will quickly turn into a paralyzed state. When the intracranial pressure is significantly increased, the state of consciousness can deteriorate rapidly, 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. This syndrome is common in cases of slow-growing intracranial tumors (Gelder et al., 1983), but localized lesions adjacent to the base 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. Early in the patient can show near memory loss or forgetting, the memory of past experiences can not be reproduced, and even new memories are distorted. But in general, instant memory can be relatively good. Disease progression can lead to disorientation, antegrade amnesia, and Coxakov syndrome with fiction. The patient is often indifferent to the defects of memory.
3 Dementia: Patients with brain tumors that grow slowly and have a long-term disease can exhibit dementia, which is a defect in calculation, understanding, and judgment. This symptom can be detected in time because it cannot adapt to work. Glioblastoma, a rapidly infiltrating glioma, can also cause mental decline shortly after onset. Sachs (1950) pointed out that meningioma can cause dementia, especially in elderly patients with brain tumors. For any rapidly developing dementia, especially if it is not commensurate with the patient's physical condition, the presence of a brain tumor should be suspected. Middle-aged and elderly patients with increased intracranial pressure may have amnesia syndrome in the early stage, and the late stage is often dementia. There may be slow thinking, lack of thinking content, empty words, incoherent sentences, disordered behavior and peculiarity, incomprehensible and intelligent barriers.
Case: Male, 19 years old, unmarried, worker. Usually, the work performance is excellent, and the unit intends to mention it as a cadre, but the self-satisfaction during the assessment is contrary to the leadership. Drowsiness after illness, decreased work efficiency, and daze. On the third day, I was bedridden, and I needed to take care of my life. I closed my eyes all day, with poor orientation and memory loss. In the near future, the situation will not take care of itself, and the situation is getting worse. On the 12th day after hospitalization, the autopsy revealed a large dermoid cyst of the left temporal lobe. The tumor originated from the indoor side of the left cerebral side, filling the entire left side of the left side chamber, and the left brain volume was enlarged. The cause of death is the formation of hippocampus on both sides.
4 schizophrenia-like psychosis: Although intracranial tumors can induce schizophrenia, the two may be associated with more than expected opportunities, suggesting that there may be special parts of brain tumors can cause schizophrenia-like psychosis. Such cases are clinically similar to schizophrenia, but the course of the disease is short, and the delusional content is not absurd. There are more auditory hallucinations in the hallucinations, as well as illusions, illusions and magical touches. Sometimes it is possible to detect hypersensitivity or disappearance and a comprehensive barrier to perception. Perceptual disorders often occur simultaneously with behavioral abnormalities.
Case: Male, 38 years old, married, worker. I started a headache 2 years ago. It was in the forehead and left ankle. It was twitching pain and improved after a break. One year later, nausea and vomiting and nighttime convulsions occurred. The headache gradually worsened, the reaction was slow, the emotion was indifferent, the mental retardation was slow, the calculation was slow, the left nasal canal was shallow, the tongue was left, and the ultrasound showed the midline deviation. Surgery confirmed to be frontal lobe meningioma, the patient was suspicious after surgery, suspected that the surgeon had an abnormal relationship with his lover, doctors, unit comrades and lover colluded to harm him. He thought that the rice was poisonous and refused to eat. The doctor gave him a lot of inexplicable injections to harm him. Give chlorpromazine, perphenazine and other drugs ineffective, on the 8th day after surgery, suicide attempted, causing splitting of the head and rupture of the spleen, after surgical rescue and recovery, the mental symptoms have not improved, think surgery Doctors have to marry their lover, and there are impulses from time to time. Due to management difficulties, he was transferred to the psychiatric department. After a few attempts to dissipate, he felt sorry for the person and apologized to the surgeon.
5 affective disorders: intracranial tumors with less emotional disorders. Generally speaking, the emotions are indifferent, depression, mostly indifferent to the outside world, the expression is sluggish, lack of initiative; also can 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. Patients with frontal lobe tumors show naive, occasionally euphoric symptoms.
Case: Male, 52 years old, married, cadre. He was admitted to hospital after repeated episodes of mental disorder in the past 10 years. Insomnia, dizziness, depression, and rest at home since 1980. Because of previous (1976) gastric disease surgery diagnosed as gastric cancer in situ, at this time also worried about whether or not suffering from brain cancer, was excluded by head CT examination. In 1981, his wife went out to play cards and his daughter was dissatisfied with his boyfriend. The performance was easy to provoke. He also suspected that his wife and daughter were not good at themselves and were relieved by outpatient medication. In 1983, the drug was discontinued, and the performance was the same as before. In March 1985, there was a slight episode, and the performance was irritating, and it was quickly controlled after taking the drug. In 1986, paroxysmal right facial twitching and right ear hearing loss occurred. In 1988, due to the onset of drug withdrawal, there was a lot of excitement and squandering. I was squandered everywhere. I visited teachers and students who had not been in contact for many years. For the 50th birthday, I would like to be a guest, smart and capable. Routine review of the head CT, found that the right cerebellum pons horn area has a low-density space-occupying lesion in the middle and posterior fossa, with the possibility of intracranial epidermoid tumor. The psychotic symptoms were controlled again. Mild disease fluctuations occurred in 1988 and 1989, but most of the time was normal. In 1991, he was again insomnia, excited about words, buying food indiscriminately, nostalgia, constantly visiting friends, admiring opinions, and boasting his talents. The original lesions were still visible in the CT examination, and their morphology, location, size and density were not significantly changed. This case is an effect of affective disorders 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. The compensation behavior for organic defects is non-specific, found in brain damage and other brain organic diseases, see the chapter on mental disorders associated with brain injury.
7 personality changes and behavioral abnormalities, lack of initiative, reduced interest, lazy life, passive behavior, ignorance, lack of shame, lack of active eating, staying or bedridden all day long, silent, or even stupor; 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 and analyzed to make a correct judgment. The appearance of psychiatric symptoms varies depending on the location of the tumor invasion. The localization symptoms of brain tumors in each part have their own characteristics, which can be judged according to the neuroanatomical structure and physiological function of the site.
(1) Frontal lobe: The frontal lobe is located in front of the central ditch and above the side fissure. The lateral and lateral surfaces of the frontal lobes are supplied by the middle cerebral artery, and the medial side is derived from the anterior cerebral artery. Frontal lobe tumors can manifest three obstacles, namely, free movement, language expression and mental activity.
1 Random movement: The frontal lobes effervescent through the pons to the contralateral cerebellar hemisphere, and the mutual movement is adjusted. Tumors on the lateral side of the frontal lobe can cause symptoms of contralateral limb ataxia, but no nystagmus. In the central anterior gyrus, the tumor in the motor area 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 Spiritual activities: Mainly manifested in mental retardation, indifferent expression, memory, attention, understanding and judgment, decreased thinking and comprehensive ability, not paying attention to neatness, not knowing the urine. Sometimes there are strong grips and groping reflections, and the main hemisphere can be damaged with aphasia.
A. Personality changes: The behavior of patients with frontal lobe tumors becomes indulgent and clumsy, emotionally euphoric, childish, and stupid. Patients with frontal lobe tumors are characterized by the simultaneous presence of opposite emotions and will activities, such as euphoria and emotional apathy, love jokes and indifference to the surroundings. Irresponsibility, irritability 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 showed apathy, lack of interest in the surrounding, not paying attention to neatness, dullness, carelessness, loss of imagination and thinking ability, lack of initiative, memory and mental decline, slow action, confused facial expressions, and stagnation.
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 scorpion tumors cause more serious mental symptoms than other parts. Mainly due to the damage of the adjacent frontal lobes and the midbrain and midbrain. 92% of tumors in the corpus callosum showed psychiatric symptoms, 57% in the middle and 89% in the compression (Schlesinger, 1950). Selescki (1964) also believes that the front and back are more common. Significant mental decline has occurred in the anterior tumor of the corpus callosum before significant signs of nervous system, headache, and increased intracranial pressure (Lishman, 1978). Emotional disorders and intelligent defects can occur clinically. The anterior and middle third of the corpus callosum may have speech disorders such as lack of speech, imitating speech, and lack of verbal comprehension. When the posterior part of the carcass is damaged, memory and disorientation often occur, and the recognition of surrounding things is also difficult. Since the tumor easily damages adjacent brain tissue, such as the third ventricle, the diencephalon, and the cingulate bundle, it may be accompanied by a richer mental condition. Personality disorders in corpus callosum are similar to those caused by frontal lobe tumors. Drowsiness, lethargy, and exercise can not be seen in the brain area, and the strange abnormal posture is similar to stress disorder.
(3) temporal lobe: mental symptoms are obvious when the temporal lobe is tumor. There are many increased intracranial pressure, visual field defects, sensory aphasia, epilepsy, mental autonomic disorder, hallucinations, and deep lesions may have contralateral unilateral blindness or 1/4 visual field defect. Sensory aphasia can occur in the primary hemisphere lesion. Because the temporal lobe is adjacent to the frontal lobe and has close fiber contact, there may be some frontal lobe symptoms, such as personality changes, no desire-exercise-incompetence syndrome, and stupor. Tumors that are confined to temporal lobe can have two forms of mental disorders, including behavioral and emotional changes in the onset of seizures and seizures.
1 Hookback episode: The attack often starts with a scent and a scent, and suddenly smells or tastes a stench or a strange smell, some may be accompanied by mild vertigo, followed by a confused and dreamlike state called a hook-back episode. At that time, the patient was unrealistic, such as the familiar or old things, the large or small objects, and the surrounding sounds were particularly loud. The perception of space and time has also changed. I feel that the near object is far away, and the time is like a movie-like lens-like flight. It takes a long time to experience a flash, and there is a feeling of upper abdomen discomfort, accompanied by fear. The illusion can be primitive, seeing the light, but the complex illusion of dreams is more common. Rhapsody is rare, often intertwined with other forms of illusion to form a compound dreamlike experience. At the time of the attack, the mouth can be automatically moved, such as chewing, rubbing lips, and tasting exercise.
2 automatic symptoms: automatic symptoms are also common, mostly in the evening. The forms of automatic diseases are varied and often lasted for a short time and forgotten afterwards. Patients can only have simple movements, such as walking around indoors without purpose, tidying up clothes, moving things, and sometimes more complex behaviors such as roaming out. As a specific patient, each auto-sickness episode is the same.
3 Behavior and mood changes during the onset of seizures: Personality changes in temporal lobe tumors are not specific, as in the case of frontal lobe tumors. Strobos (1953) found that 11% of patients with temporal lobe tumors had a tendency to be pathologically personality and paranoid, focusing on their own 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. Frequent outbursts and rapes often occur. Some patients with temporal lobe tumors have symptoms such as anxiety and depression, and need to be distinguished from depression.
It is not uncommon for 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 are caused by tumors that induce or induce the onset of genetic schizophrenia, and others may be directly caused by temporal lobe lesions.
(4) parietal lobe: parietal tumor caused less mental symptoms than frontal lobe or temporal lobe tumor. It is easy to cause cognitive dysfunction, mainly sensory disturbance. Symptomatic epilepsy, contralateral limb, trunk sensation (including cortical sensation), paroxysmal paresthesia, and disuse are common. The main hemisphere lesions may have loss of reading, loss of writing, miscalculation, and autism of the autologous site. Because the parietal lesions cause early signs of movement and sensation, they are less misdiagnosed as psychosis. In patients with parietal lobe, high-level sensory function defects can occur. Patients have many complex cognitive activity disorders. Bilateral parietal lesions can cause difficulty in visual space judgment and terrain orientation disorder.
The formation of body image is the result of the synthesis of the parietal cortex through the proprioceptor. Therefore, patients with parietal tumors may have various body image disorders, such as unilateral unawareness or neglect, hemisomatognosis, anosognosis, and autotopagnosia. , reduplication phenomenon, amorphosynthesis, etc. The patient's sense of touch and pain are not impaired, but they cannot be identified by touch, that is, the physical sensory disorder (astereognosis). It is impossible to say what the word or figure of the palm of the hand is, and the sense of writing is lost. Appearance agnosia can be seen when the posterior parietal tumor affects the occipital lobe.
Patients with parietal tumors may have depression, and personality disorders are less common. Such patients do not pay proper attention to the left and right of the body and surrounding things (such as clothes), patients may have clothing defects and difficulties, known as dressing apraxia 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, with illusion being the most common. There are no clear limitations except for visual field defects. The clinical side produces contralateral omnilateral hemianopia. The main hemisphere lesions may have visual agnosia, that is, they do not recognize the objects and colors seen. The lesions in the parietal lobe and posterior temporal lobe showed only a contralateral lower 1/4 or upper 1/4 visual field defect. For stimulating lesions of the occipital lobe, primitive illusion can be seen. A complex visual illusion occurs when the occipital lobe tumor affects the parietal lobe and temporal lobe. Because the tumor here causes an increase in intracranial pressure earlier, there may be corresponding mental symptoms.
(6) Diencephalon: The tumor can damage the thalamus, the hypothalamus, and the adjacent third ventricle. It can express metabolic disorders, endocrine disorders, autonomic dysfunction, neuropsychiatric disorders, and the like. Shows more significant mental symptoms. Such as obvious memory defects, intelligent decline. Personality changes include: irritability, allergies, impulsivity, excitement, irresponsibility for work, carelessness, carelessness, childishness, stupidity, and personal habits.
14%(WilliamsPennybacker1954)-
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(7)310min
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Diagnosis
Differential diagnosis
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5. 20%CTMRI6%(SerafetinidesDominian1962)
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CCMD-2-R
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