850 - Multifactorial Contributors to Pseudobulbar Affect and Depression in a Cancer Patient: The Role of Vitamin Deficiency and Neurological Injury, A Case Report

Case Diagnosis: 65 year old male with metastatic lung cancer to brain, status post craniotomy and resection of right frontal lobe mass, presenting with left hemiparesis with pseudobulbar affect and post surgical depression.

Case Description: On admission to acute rehab unit, physical exam revealed left hemiparesis.  The patient also exhibited pseudobulbar affect (PBA), becoming tearful moments after laughing.  Initially, it was thought that the tumor's location in the right frontal lobe, which is involved in emotional regulation, was the cause of this dysfunction. However, further work up revealed significant vitamin deficiencies, which can occur in cancer patients and are associated with mood disturbances and depression.  Blood tests showed deficiencies in folate, vitamin B12 and vitamin D.  The patient was prescribed appropriate supplementation.  After several days of treatment, the patient demonstrated improvement in emotional lability and PBA.

Discussions: Pseudobulbar affect is a neurologically mediated condition causing sudden uncontrollable episodes of laughing or crying.  While PBA is often linked to neurologic damage such as from brain tumors or surgery, it can also arise from multifaceted medical issues, as seen in this case.  Here, vitamin deficiencies, depleted by the cancer, played a biological role in the emotional dysregulation.  Recognizing and treating such underlying factors, alongside addressing neurologic causes, is essential to improving emotional stability.

Conclusions: In conclusion, this case highlights the complex interplay between neurological injury and metabolic disturbances, such as vitamin deficiencies, the the development of PBA and mood disorders in cancer patients.  While the tumor's location in the frontal lobe was initially though to be the sole cause, further investigation revealed significant vitamin deficiencies which also contributed to his emotional instability.  This case underscores the importance of a thorough medical workup in addressing the multifactorial causes of emotional dysregulation in cancer patients.  Early recognition and treatment of both neurological and metabolic factors can lead to better outcomes.