Secondary mania caused by olfactory groove meningioma: A case report

The major clinical manifestations of orbitofrontal cortex lesions include disinhibition, perseveration and obsessive-compulsive and antisocial behaviours. Some patients with orbitofrontal cortex lesion can show mood elevation. We report a 69-year-old female who presented with manic and inappropriate emotional responses caused by a large olfactory groove meningioma. Magnetic resonance imaging showed a large, extra-axial mass with homogenous enhancement in the olfactory groove, compressing the orbitofrontal cortex. She showed no focal or lateralising neurological signs. We did standardized neuropsychological batteries, including the Young Mania rating scale to evaluate her manic symptoms. After removal of the tumour, her manic symptoms and abnormal behaviours gradually disappeared. These findings suggest that her manic symptoms might have resulted from compression of the orbitofrontal cortex due to the olfactory groove meningioma. Clinicians must have an index of suspicion for organic brain lesion compressing the orbitofrontal area when a patient without a history of psychiatric disease develops progressive manic symptoms.