Can a right frontal convexity mass in the brain cause hallucinations and behavioral agitation?

From the Guidelines

Yes, a right frontal convexity mass in the brain can cause hallucinations and behavioral agitation. Brain masses in the frontal lobe can disrupt normal brain function by exerting pressure on surrounding tissue, interfering with neural pathways, or causing inflammation. The frontal lobe is responsible for executive functions, personality, behavior regulation, and emotional control, so tumors in this region commonly lead to behavioral changes including agitation, impulsivity, and poor judgment. While hallucinations are more typically associated with temporal lobe involvement, they can occur with frontal lobe masses due to disruption of neural circuits connecting different brain regions. Symptoms may vary depending on the exact location, size, and growth rate of the mass. Treatment typically involves addressing the underlying mass through surgical resection, radiation therapy, or chemotherapy depending on the type of mass. Symptom management might include antipsychotics like risperidone (0.5-2mg daily) or quetiapine (25-200mg daily) for hallucinations, and benzodiazepines such as lorazepam (0.5-2mg as needed) for acute agitation, as suggested by 1. Any patient experiencing these symptoms should undergo immediate neuroimaging and neurological evaluation to identify the cause and determine appropriate treatment, as recommended by 1.

Some key points to consider in the management of these patients include:

• The importance of early diagnosis and treatment to prevent further decline and improve outcomes, as highlighted by 1.
• The need for a comprehensive diagnostic evaluation, including neuroimaging and laboratory tests, to rule out other potential causes of symptoms, as emphasized by 1.
• The use of antipsychotic medications, such as risperidone or quetiapine, for the management of hallucinations and agitation, as suggested by 1 and 1.
• The potential benefits and risks of different treatment approaches, including surgical resection, radiation therapy, and chemotherapy, as discussed by 1.

Overall, the management of patients with a right frontal convexity mass and hallucinations or behavioral agitation requires a multidisciplinary approach, including neurology, neurosurgery, psychiatry, and other specialties, as well as careful consideration of the individual patient's needs and circumstances, as recommended by 1 and 1.

From the Research

Hallucinations and Behavioral Agitation in Right Frontal Convexity Mass

• The relationship between right frontal convexity mass and hallucinations, as well as behavioral agitation, can be complex and is supported by various studies 2, 3, 4.
• A case report from 1993 describes a 55-year-old woman with a right frontal lobe tumor who experienced severe delusions and seizures, which resolved after tumor removal 2.
• Another study from 2018 found that patients with locked-in syndrome and hallucinations had selective cortical volume loss in areas such as the fusiform and parahippocampal gyrus, and the orbital part of the inferior frontal gyrus in the right hemisphere 3.
• Research on brain modules of hallucination suggests that focal brain lesions causing isolated hallucination in a single sensory modality are typically located in the brain pathway of that sensory modality, and that compensatory overactivation of nearby brain tissue may contribute to hallucinosis 4.

Right Frontal Convexity Mass and Psychiatric Symptoms

• A 2022 case report describes a 29-year-old woman with a right frontal lobe grade 2 malignant glioma who presented with depression, psychomotor retardation, and reduced fluency of speech, highlighting the importance of considering underlying organic lesions in patients with atypical psychiatric symptoms 5.
• The study emphasizes the need for thorough history taking, physical examination, and neuroimaging tests in cases of recent-onset psychosis or mood disorder symptoms, especially in young patients with no history of psychiatric disease 5.

Surgical Management of Convexity Meningiomas

• A 2008 study on the surgical management of convexity meningiomas found that these tumors can be safely removed using modern image-guided minimally invasive surgical techniques, with a low operative mortality and recurrence rate for benign tumors 6.
• The study highlights the importance of considering the pathological factors leading to recurrence, such as borderline atypical features and high MIB-1 indices, in the management of convexity meningiomas 6.