Frontal Glioblastoma Presenting With Catatonia: A Case Report

Abstract

This case highlights the need for thorough medical and neurological screening before making any psychiatric diagnosis, even if the patient has a classical syndromic presentation. Presented here is a case of a female in her late 40s coming to our psychiatric outpatient with symptoms suggestive of catatonia. She was treated at a private clinic for depression. As her symptoms deteriorated, she was brought to our hospital for further management. She was diagnosed with catatonia during admission assessment. A detailed neurological assessment later revealed slight weakness in the right upper and lower limb. Following this, a CT scan was done and was reported to have a hypodense area involving the bilateral frontal and basifrontal region, more pronounced on the left side (likely to be acute/subacute). MRI was subsequently done and was found to be suggestive of glioblastoma NOS (not otherwise specified) involving the bilateral cerebral hemisphere which was later confirmed by the histopathology report.

Keywords: catatonia; catatonia in glioblastoma; catatonic symptoms; frontal glioblastoma; frontal lobe glioblastoma; glioblastoma; glioblastoma and catatonia; glioblastoma tumour; psychomotor disturbances with glioblastoma.

Figure 1. CT brain showing hypodense areas in the bilateral frontal and basifrontal regions, more pronounced on the left side. The hypodense areas extend to the rostrum and body of the corpus callosum on the left side, causing mass effect and midline shift.

Figure 2. MRI brain showing a large heterogeneous lesion that is hyperintense on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences. The lesion is noted in the genu and adjacent body of the corpus callosum, as well as in both frontal lobes and the left basal ganglia.

Figure 3. MRI brain showing the lesion with thick, irregular peripheral enhancement on T1 post-contrast imaging. These features are suggestive of glioblastoma.

Figure 4. Histopathology showing sections with multiple fragments of an infiltrating cellular tumor of astrocytic origin. The tumor presents as sheets of cells with mild to moderate pleomorphism. The background is fibrillary and contains extensive areas of geographical necrosis and microvascular proliferation, with some vessels displaying a glomeruloid appearance. These features are consistent with a high-grade astrocytic neoplasm, specifically glioblastoma NOS (not otherwise specified).