Bilateral Thalamic Astrocytoma Presenting as Depression and Cognitive Impairment

The thalamus is the relay site for most afferent pathways. Thalamic lesions cause mental symptoms such as depressive symptoms, anxiety, poor attention and concentration, and memory disturbances. This case report describes a 35-year-old female patient who presented with sadness, disinterest in daily activities, anxiety, crying spells, and other mental symptoms. On detailed inquiry, she was also found to have reduced attention, concentration, and short-term memory disturbances, with no focal neurological deficit on examination. Imaging with magnetic resonance imaging brain revealed a bilateral thalamic low-grade astrocytoma. This case demonstrates that a careful understanding of the apathy and cognitive dysfunction in the presence of depression/anxiety is consequential. In this case, there is more to the clinical presentation of the symptoms of depression and anxiety than meets the eye. The expressionless face, apathy, and a certain degree of unawareness mark out the familiar depressive and anxiety symptoms from cognitive decline seen in thalamic lesions.