Psychiatric symptoms associated with frontal lobe unruptured or ruptured intracranial dermoid cysts are rarely described in the medical literature. The case of a 58-year-old man with a chronic history of anxiety, major depression, and obsessive compulsive disorder who presented with new onset auditory and visual phenomena is described. This case illustrates the need to include an underlying brain tumor in the differential diagnosis when encountering new onset auditory and visual phenomena in patients with chronic mood and/or anxiety disorders.
Key Points
* Slow-growing embryonal intracranial unruptured dermoid cysts may produce psychiatric symptoms without neurologic signs.
* Chronic symptoms of depression and obsessive compulsive disorder resulting from slow-growing intracranial dermoid cyst mass effect may be reversible with tumor extirpation.
* Irritation of the temporal lobe and optic tracts by the cholesterol particles derived from keratin breakdown after intracranial dermoid cyst rupture may result in brief and recurring auditory phenomena and visual phenomena, respectively.
* A thorough history regarding the length and character of visual and auditory phenomena are essential in differentiating functional psychotic symptoms from organic brain phenomena in patients with chronic mood and anxiety disorders and with a positive family history of schizophrenia.