Síndrome de Cotard tras la resección quirúrgica de un meningioma frontal derecho

Objective

We present a case of Cotard's syndrome in a patient seen by the Liaison Psychiatry Team (EPE) after surgical resection of a meningioma. We carried out a historical review of the picture and its presentation in relation to structural brain damage.

Clinical case

Man in his thirties with no psychiatric history presented with insidious onset nihilistic delusional ideation with behavioral repercussions on the sixth day after neurosurgery for a right frontal meningioma. We clinically ruled out delirium.

Results

Antipsychotic and anxiolytic treatment was initiated, with progressive reduction until complete withdrawal on the tenth day due to behavioral improvement and partial encapsulation of the delirium that was maintained on an outpatient basis. The neuroradiological evolution was favorable and there were no metabolic or infectious complications. In the outpatient neuropsychological evaluation, cognitive difficulties compatible with the lesion were recorded, the presence of which could be prior to surgery.

Conclusions

Cotard's syndrome is a rare and under-researched condition that may be associated with supervening brain damage. The right hemisphere seems to play a leading role in perceptual integration and the relationship with the self, and its alterations have been related to the appearance of monothematic syndromes such as the one described here.