表情平坦為早期症狀的額葉腦瘤個案：以一名輕微神經學徵候但有明顯社會心理壓力事件者為例

Apathetic Affect as Early Sign of Frontal Lobe Tumor in Patient without Obvious Neurological Findings but with Remarkable Psychosocial Stressors

背景：對精神科醫師而言，腦瘤是否可有效地以精神病理學特徵來診斷，是一重要的議 題。個案報告：我們報告一名中年男性病人，在明顯的社會心理壓力事件後出現只有表情平 坦的臨床特徵。此個案在就診之初，並未顯現明顯之神經學徵候，一度被診斷為憂鬱疾患。 但腦部造影最終顯現一巨大之多型性膠質母細胞瘤。結論：此個案報告顯示，表情平坦可為 額葉腦瘤的早期表現，其出現時間有可能在明確的神經學徵候產生之前。對於合併社會心理 壓力事件與不典型臨床精神病理的個案，腦瘤仍是重要的鑑別診斷，且不應被社會心理化解 釋掩蓋或誤導。

Background: Whether a brain tumor can be effi ciently detected by psychopathology is an important issue for psychiatrists. Case Report: We present was a 44- year-old male patient who showed apathetic affect after suffering from psychosocial stressors. He was diagnosed as a depressive disorder for a time due to not having obvious neurological signs at his fi rst psychiatric clinic visit, but imaging studies fi nally revealed the fi nding of a huge glioblastoma multiforme. Conclusion: This case report shows that apathetic affect can be an early sign of a frontal lobe tumor, which may be found before the development of defi nite neurological signs. In patients with both remarkable psychosocial stressors and atypical clinical presentations, brain tumor is still a diagnosis of concern and should not be underestimated or overlooked.