We report the case of a 39 year old male who presented with Major Depression, headache, and apathy. Within six weeks of his initial presentation the patient died from a "Central Herniation Syndrome" after biopsy of a left thalamic lesion. The statistics of medical problems presenting as psychiatric disorders as well as recent literature on personality changes associated with thalamic infiltration are reviewed.
It is recognized that from 33-80% of inpatient psychiatric patients have concurrent medical disease. A large proportion of these are unrecognized prior to psychiatric hospitalization (1). In 1983, Martin clearly stated that "psychiatric symptoms are often the earliest and occasionally the only symptoms of intracranial tumor." Martin also reported that slow growing tumors were associated with depression and personality changes. Primary tumors of the thalamus were described by Smyth and Stern over fifty years ago when they described that these patients had a flat affect, decreased verbal output and apathy (3).
Claire, M.D., Robert Jay
"Thalamic Tumor Presenting as Major Depression and Headache,"
Jefferson Journal of Psychiatry:
1, Article 11.
Available at: http://jdc.jefferson.edu/jeffjpsychiatry/vol11/iss1/11