Exploring Secondary Mania: A Case of Medial Frontal Meningioma With Exceptional Response to Antimanic Medication

Mania is typically associated with psychiatric disorders but can also be secondary to other conditions, such as brain tumors. A notably rapid response to antimanic treatment suggests secondary mania. However, identifying such cases can be challenging. Mrs. M., a 52-year-old woman with a history of anxiety and dysthymia, presented with her first manic episode, marked by elevated mood, agitation, reduced sleep, racing thoughts, and grandiose delusions. Her manic symptoms emerged outside the usual age range for mania. She responded remarkably quickly to antimanic medication. Furthermore, her Young Mania Rating Scale (YMRS) score decreased from 36 to 6 within 3 days. This unusual response prompted further investigation, revealing a 46 mm enhancing mass in the medial frontal lobe, affecting the anterior cingulate cortex (ACC). This was confirmed as a meningioma upon surgical removal. The rapid treatment response, combined with the atypical age of onset, raised the suspicion of secondary mania. The discovery of a medial frontal meningioma and its subsequent surgical removal supported this diagnosis. Given the ACC's role in emotional regulation, its involvement likely contributed to the manic symptoms. A swift response to antimanic treatment can indicate secondary mania, such as that caused by a brain tumor. This case highlights the importance of considering secondary causes when mania presents atypically or responds unusually well to treatment.