Psychiatry and neurosurgery do not usually argue over the same patient. A case published this year in the Oxford University Press journal Archives of Clinical Neuropsychology puts one squarely between them.
The report, by Candace Marsters, appears in volume 41, issue 5, under the title " Serial neuropsychological assessment of multiple meningiomas complicated by psychosis following ventriculoperitoneal shunt revision. The patient had multiple meningiomas and a shunt draining cerebrospinal fluid from the brain to the abdomen. After that shunt was revised, psychosis followed, and the case was tracked with repeated neuropsychological testing rather than a single snapshot.
The obvious question is what caused it. The honest answer is that in cases like this, nobody can fully separate the possibilities.
Where a Tumor Sits Changes What the Mind Does
Meningiomas grow from the membranes covering the brain and spinal cord and are the most common primary central nervous system tumors. They grow slowly, which is why so many are found by accident on scans done for other reasons. It also means that when they do cause trouble, the trouble can be behavioral long before it is neurological.
An individual patient data analysis published in the Asian Journal of Psychiatry in 2019 by Gyawali, Sharma, and Mahapatra gathered the published case literature on meningioma and psychiatric symptoms. Searching for reports involving depression, bipolar disorder, mania, psychosis, and obsessive-compulsive disorder, the authors found varied psychiatric presentations in patients whose tumors differed in site, size, and side. Their central warning was that diagnosis gets delayed when psychiatric symptoms are the only thing on show, and that patients presenting to psychiatry with atypical symptoms need neurological examination and imaging.
The overlap is easy to underestimate. A clinical series by Gupta and Kumar, cited across this literature, found that 21% of meningioma cases presented with psychiatric symptoms in the absence of neurological ones.
The Shunt Belongs on the Suspect List Too
A ventriculoperitoneal shunt is a valve and tube that drains excess cerebrospinal fluid out of the brain's ventricles. Revising one changes pressure inside the skull, sometimes substantially and sometimes quickly, and the structures around the ventricles re-expand.
There is literature suggesting that it carries its own psychiatric risk. A 2014 report in Case Reports in Psychiatry described a woman who underwent shunt replacement for recurrent hydrocephalus caused by earlier radiation treatment. Imaging two days later confirmed the hydrocephalus had resolved and her ventricles had shrunk. Two days after discharge she became hyper-talkative and irritable, then developed near-total insomnia, grandiosity, flight of ideas, and persecutory delusions. Her psychiatric history had looked empty until a detailed reassessment turned up longstanding subthreshold bipolar features. Her clinicians proposed that upregulated binding at striatal dopamine D2 receptors after the shunt replacement triggered the episode, an interpretation of one case rather than a demonstrated mechanism.
Dopamine appears elsewhere in this literature. Parkinsonism has been reported after ventriculoperitoneal shunting, in one case four years after an otherwise successful procedure, with symptoms that worsened on antipsychotic drugs and responded to levodopa.
Shunt problems can run the other way. A 2024 case report in Frontiers in Psychiatry described a 34-year-old man carrying a 16-year diagnosis of depressive disorder whose low mood and cognitive impairment failed to respond to antidepressants. The problem was inadequate drainage from his shunt. Increasing the drainage, alongside a low dose of olanzapine, produced significant improvement, and the final diagnosis was recorded as an organic mental disorder.
The Red Flags That Send a Psychiatrist to Order a Scan
None of this means psychiatric symptoms usually indicate a brain tumor. They usually do not, and most people with new psychosis have no structural lesion at all.
What the literature offers instead is a set of triggers for imaging. The 2019 analysis identified the circumstances that prompted a neuroimaging workup in published cases: psychiatric symptoms that appear suddenly or look atypical for the presumed diagnosis, symptoms that fail to respond to the usual line of treatment, and the presence of neurological signs such as headache, seizures, double vision, or urinary incontinence.
Serial neuropsychological testing, the method at the center of the new case report, is useful here precisely because it produces a trajectory rather than a verdict. Tracking cognition across time can show whether function is recovering, plateauing, or deteriorating, information a single assessment cannot supply.
The limitation of a single case is the same as always. It demonstrates that a sequence of events occurred in one person. It cannot establish that the shunt revision caused the psychosis, that the meningiomas did, or that the timing was anything more than coincidence. Anyone experiencing new or worsening psychiatric symptoms, particularly alongside headaches, seizures, or vision changes, should be assessed by a clinician.
Key Questions Answered
What does the new case report describe? A patient with multiple meningiomas who developed psychosis after revision of a ventriculoperitoneal shunt, followed by repeated neuropsychological assessments. It appears in Archives of Clinical Neuropsychology, volume 41, issue 5.
Can brain tumors cause psychiatric symptoms? Yes. Published case literature documents mood symptoms, psychosis, personality change, and other presentations in people with meningiomas, sometimes as the only presenting feature.
How often are psychiatric symptoms the only sign? One clinical series found that 21% of meningioma cases presented with psychiatric symptoms and no neurological ones, which is a major reason diagnosis gets delayed.
Could the shunt surgery itself be responsible? It is on the list. Case reports document a manic episode with psychotic features shortly after a successful shunt replacement, parkinsonism after shunting, and depressive symptoms caused by inadequate shunt drainage that improved when drainage was increased.
Does this mean psychiatric symptoms usually signal a brain tumor? No. Structural lesions account for a small minority of psychiatric presentations. The literature identifies specific circumstances, such as sudden or atypical symptoms or accompanying neurological signs, that warrant brain imaging.
What should someone do about new psychiatric symptoms? See a clinician and mention any headaches, seizures, vision changes, incontinence, or recent brain surgery, since those details influence whether imaging is appropriate.
