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Mood Disorders Associated with Acoustic Neuromas

Objective: The primary purpose of this article is the presentation of three cases of manic and mixed states associated with an acoustic neuroma, and review of the literature on psychiatric symptoms accompanied by the tumor. Methods: The cases were identified from 830 consecutive inpatient psychiatric admissions over age fifty-five years. Patients were assessed using a Structured Clinical Interview (SCID-R), and met DSM-III-R criteria for the diagnosis of bipolar disorder. The psychopathology seen in acoustic neuroma patients and the pathophysiologic mechanisms proposed to explain them are reviewed. Results: The cases we report differ from other cases in the literature in that psychiatric symptoms began pre-operatively and remained for long periods post-operatively. The psychiatric signs and symptoms reported in acoustic neuroma patients are usually described as transient, and these include mood changes, agitation, persecutory delusions, hallucinations, and memory loss and confusional episodes. The disruption of brainstem structures including the auditory pathways, the cerebellum and the ascending reticular system may contribute to mood changes. Systematic studies are necessary to examine their relationship. Although psychological reactions attributable to surgery and facial paralysis may serve as contributory factors the evidence for their role was not striking in the cases we report.