Manic Patient with Meningioma Treated with Low dose Risperidone and Valproic Acid

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We describe the case of a 73 year-old female patient, YSG, who initially presented with a manic episode without any previous psychiatric history and was later diagnosed as having a meningioma in the left frontal lobe. YSG's symptoms were characterized by hyperactivity, insomnia, aggressive behavior with an auditory hallucination. She showed no abnormal signs on a complete neurologic examination. A gadolinium-enhanced MRI study showed a huge, extra-axial mass with homogenous enhancement in the left high convexity of the frontal lobe. Her manic symptoms subsided after administration of risperidone 1mg and valproic acid 500mg daily, for three weeks without surgical resection of the tumor. These findings suggest that YSG's mania might have resulted from the left-sided frontal tumor, and that her symptoms were treated rapidly by small doses of risperidone combined with valproic acid. Medical staff who care for manic patients should be aware of this possibility of a organic lesion without evidence of neurologic disease.