Giant wing sphenoid meningioma with principal manifestation depression

A 68-year-old woman with no previous mental illness presented with a three-month history of decreased energy, fatigue, feelings of hopelessness, pessimism, difficulty concentrating, and persistent feelings of "emptiness", worthlessness, insomnia, appetite loss, diminished functionality. The patient's neurological examination was normal. She was diagnosis with major depressive disorder (MDD) by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria and received psychiatric treatment. Resistance at therapy leaded at cerebral axial computed tomography (CT) indication. Cerebral CT-scan revealed an intracranial expansive mass (EPIC) located in frontal-temporal (F-T) right lobe, size 42/45/66 mm, hyperdense lesion, without peri-lesional edema, inserted on the great sphenoid wing, image suggestive for meningioma. MRI confirmed the presence of tumor and angiography showed the arterial source of the meningioma. The neurosurgical intervention removed successfully the tumor. Grossly examination revealed a giant tumor with a maximal diameter of 7 cm. The histological aspect of the tumor was highly representative for the diagnosis of meningioma. Patient mental status was evaluated at baseline, in preoperative period and postoperative period and had been using Hamilton Depression Rating Scale (HDRS) - 17 items version, Clinical Global Impression Scale (CGI), and Global Assessment of Functioning (GAF). After neurosurgical intervention, functioning was improving with completed remission of depression symptoms at six-month postoperative evaluation.

Most meningiomas are slow growing and many are found incidentally. The decision to perform a cerebral CT-scan depends on the clinician's degree of suspicion that a tumor is present. A first depressive episode is a clinical condition with principal indication for cerebral CT-scan.