An unusual presentation of an epidermoid brain tumour: a tale of two specialties

A 33-year-old right-handed lady was referred to the psychiatry and neurology services by her general practitioner. Previously, she was under psychiatric care for bipolar affective disorder. Recently, her mood had deteriorated prompting the re-referral to the psychiatrists. In addition she had strange attacks. These strange attacks seemed to her like 'sensory overload' or that the 'brain just stops'. Other sensations throughout the attacks included feeling like she is in a 'fish bowl' and surrounding sights and sounds were distorted. She could not speak. After the attack she was hot and flustered, suffered memory loss and was tearful. Both the psychiatrist and the neurologist considered the possibility of these attacks being psychiatric in aetiology. However, the alternative possibility of a coexistence to epilepsy and depression was investigated and MRI demonstrated an epidermoid tumour with the supratentorial portion displacing the left temporal lobe.