Left Frontal lobe Meningioma masquerading as Schizophrenia

Meningioma is slow growing tumor of meninges. The symptoms can be subtle and non-neurological leading to delay in diagnosis. Unlike intracranial tumors which can presents with sensory or motor deficits, psychiatric manifestations can be the only symptoms of meningioma as it compresses the brain from outside. Psychiatric disorders of non-organic origin like schizophrenia, mania- depression related symptoms are rarely seen with meningioma. The psychopathology from this benign tumor is characterized as clouding of consciousness in acute stage and amnesia in chronic stage. Patients who are labelled as depressed or schizophrenic are infact indifferent and have mood lability without any psychological reasons. Frontal lobe tumors are known to alter whole personality, not just memory and retention. As such lack of social responsibility and morality is seen. We present as case of 46-year old male diagnosed with Schizophrenia, presenting with inattention, memory difficulties, prominent apathy, expressive language difficulties misinterpreted as disorganized thinking. He had history of wandering from one state to another, diagnosed as schizophrenia for several years with very poor response to antipsychotic medication trials. Detailed history from family indicated he was normal adult in his 20’s with progressive deterioration over the years. No known family history of psychiatric illnesses. Neuroimaging was delayed in our case due to presumed schizophrenia exacerbation for years. This case highlights importance of high degree of clinical suspicion and low threshold for neuroimaging in patients with no family history of psychiatric illness, poor response to antipsychotics and prominent features of personality change, inattention and memory impairment.