Disclosures: Jasmin Harounian, MD: Nothing to disclose

Case Description: A 66-year-old female with prior frontal lobe GBM resection status-post chemo-radiation on anti-epileptics presented with new-onset seizures and left-sided weakness. Imaging revealed recurrence of GBM. Loading doses of anti-epileptic medications were given and dexamethasone was initiated for cerebral edema. Patient underwent craniectomy with tumor resection and had post-operative psychosis. She was then transferred to acute inpatient rehabilitation.

Setting: Inpatient Rehabilitation at Academic Center

Patient: A 66-year-old female with anxiety/depression and glioblastoma multiforme (GBM) status-post prior tumor resection.

Assessment/Results: Psychiatry continued to help manage her paranoid delusions and worsening agitation. Anti-epileptic medications were adjusted, and steroids were continued. Anti-psychotic medications were initiated, and patient remained under frequent observation for safety. After an acute cognitive decline, neurology was consulted, and EEG was concerning for subclinical seizures. Anti-epileptic and anti-psychotic medications were readjusted until EEG and psychosis began to improve. Repeat imaging demonstrated pseudo-progression versus disease progression. Patient was then transferred to medicine service for re-initiation of chemotherapy.

Discussion: Acute psychosis is a common phenomenon in hospitalized patients. Patients with GBM have an underlying organic cause for neurobehavioral symptoms. For this patient, there were a multitude of iatrogenic variables involved with her psychosis including high-dose steroids, sub-clinical seizures with anti-epileptic medication dosing, and frontal tumor resection. Additionally, the patient had a pre-existing psychiatric history, which has been shown to increase susceptibility to psychological maladjustment after brain tumors. Therapy participation was limited by the patient’s psychosis, and the patient required constant verbal cues and redirection due to poor cognitive abilities.

Conclusion: Glioblastoma multiforme tumors can cause psychosis and agitation. Subclinical seizures, a prior history of psychiatric disease, and iatrogenic factors, such as anti-epileptic medications and surgery, can compound these effects. Coordination of care across multiple specialties was imperative in proper medication management for acute psychosis, continued GBM treatment and optimizing the patient’s functional capabilities while in acute inpatient rehabilitation.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/multifactorial-acute-psychosis-in-a-glioblastoma-multiforme-patient-a-case-report/