Fourteen patients aged 6 6 8 7 years are described, in whom major psychiatric problems dominated the presentation of intracranial tumour. Six had initially been referred to psychogeriatricians and eight to geriatricians. All showed intellectual failure, developing over a few weeks or months, with failure of self-care, and a variety of disturbances of behaviour. Four had undoubted and two possible seizures. Their mental state was described as facile, or slow, with relatively unimpaired memory when it could be tested. Four were inaccessible or mute. Abnormal neurological signs were absent in two, but included unilateral or bilateral hypertonia and hyperreflexia in most; the plantar responses were flexor in seven, equivocal in three, and extensor on one or both sides in four. Computed tomographic (CT) scans shows frontal or bifrontal tumours in 13, and one occipital lobe tumour. The corpus callosum was involved in eight. Ten tumours were considered to be high-grade astrocytomas (proven by biopsy in three and autopsy in one); one patient had bifrontal metastatic tumours, and three had meningiomas, all of them successfully resected. Clinical diagnosis was difficult, but a CT scan is indicated in all patients with a short history of intellectual Failure.
KEY woam-Intracranial neoplasm, geriatric psychiatry. Klotz (1957) reviews the earlier literature on predominantly psychiatric presentations of intracranial tumour, which have long been recognized, mainly in younger adults, though there is doubt as to how common this may be (Anderson, 1970;Avery, 1971;Withersty, 1974;Riison and Fossan, 1986). Although many series contain a proportion of elderly patients (e.g. three of three over the age of 60 at diagnosis (Hunter et al., 1968); four out of nine (Chee et al., 1985), the same presentation in the elderly is less well recognized. This may result from a combination of the higher frequency of psychiatric problems in all illnesses in old age, difficulties with examination and interpretation of findings, poor access by elderly patients to investigational facilities, and the erroneous view that intracranial tumours are uncommon in the elderly (Werner and Schold, 1987).