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Submitted by PatientsEngage on 29 March 2015

Prem's startling discovery of the root cause of his wife’s altered personality. Prompt diagnosis and treatment gave him back the woman he had married. 

In the summer of 2012, my wife’s behaviour started to change. Initially we attributed it to age-activated attention deficit disorder (AAADD). We noticed that she was forgetful, moving from one chore to another unmindful of the earlier one. She showed signs of indifference, depression and withdrawal. 

These symptoms were juxtaposed against her on-going arthritic problems - lower back ache and knee pain. In addition, she had been suffering from the residual effects of an attack of Herpes Zoster, which she had developed in April 2008, on the right side of her forehead, from eyelid to the skull. Even though the disease itself had subsided after a few weeks, it had left behind a trail of frequent pain and irritation in the affected nerves. This malady was classified as PHN (post herpes neuralgia) for which she had to take a few medications, like Tegretal, Triptomer, Pregabid etc, whose overall impact was depressive. In view of such a background, her loss of memory and other changes in her behaviour were thought to be due to the medication she was taking, coupled with age. She was 68 at that time. While we toyed with the idea of a consultation with a psychiatrist, the dilemma was how to convince her and what would be her reaction.

However, as the weeks and months went by, the frequency of incidences of forgetfulness and disorientation increased. For instance, she would quite often forget to switch off the gas burner or the instructions she would have given to the kitchen maid. At times, while shopping she found it hard to comprehend and hand over the amount she had to pay the shopkeeper or else fail to carry enough money for the intended purchases, embarrassing herself in the process. She also started experiencing headaches and dizziness frequently. There were occasions when, it was observed, that while some visiting relatives/friends would be sitting in the drawing room, she would unconsciously leave them and go to her bedroom. She started avoiding company. She herself had no clue as to why she was behaving that way.

Finally, on 9th August 2012, it was decided that we would consult the neurologist who had earlier advised her on PHN. He clinically examined her including her gait etc. While again prescribing Gabapin for her PHN and Shelcal OS and Risiphos 35 etc. for her arthritic problems, he advised an MRI (Magnetic Resonance Imaging) of the brain. 

MRI of the Cranium with contrast revealed:  “a well defined homogeneous enhancing extra axial lesion showing mild restricted diffusion in right frontal para-sagittal location which compresses the right frontal lobe and body of corpus callosum and right external capsule. 

There is also a mass effect on frontal horns both lateral ventricles with mild dilation of the rest of lateral ventricles and moderate midline shift to the left. There is increased enhancement along and the adjoining falx with focal thinning in the falx and lesion bulges across the midline on the left side and minimally indents the left medial frontal gyrus.” 

To put it simply, she had a tumour in the brain – a Para-Sagittal Meningioma towards the right frontal lobe. As it grows it presses the brain on the left. 

The lesion measured 5.6 x 3.7x 5.6 cm in antero-posterior, transverse and supero-inferior directions. The medical advice was for an immediate surgical procedure to remove the tumour and, later, to carry out a biopsy to determine its character. This was accomplished soon after by an experienced neurosurgeon. The tumour was excised under general anaesthesia using CVSA, suction & cautery with alternate internal decompression and peritumoral dissection. The post-operative recovery followed at reasonable pace though medication continued for a few months. Within a few weeks, she resumed her normal activities. Subsequent diagnostic tests showed no evidence of any recurrence. 

In retrospect, it was fortuitous that the malady was diagnosed well in time and remedial action completed without loss of time after its diagnosis. Without this prompt action, her situation could have become aggravated, both physically as well as psychologically.