{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T00:13:21Z","timestamp":1789172001719,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"23","license":[{"start":{"date-parts":[[2022,12,4]],"date-time":"2022-12-04T00:00:00Z","timestamp":1670112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Endometriosis is a systemic medical condition characterized by endometrial tissue that is abnormally implanted in extrauterine sites, including the central nervous system. In this article, we reported the case of a patient with presumed cerebral endometriosis who was diagnosed with bipolar disorder and panic disorder and systematically reviewed the literature for previously reported neuropsychiatric symptoms in patients with cerebral and cerebellar endometriosis. The PubMed, Scopus, and Web of Science bibliographic databases were searched according to the PRISMA guidelines. Seven previous case reports were found and described. While neurological disturbances dominated the clinical picture in the cases retrieved from the literature, our patient represented the first case to show both neurological and psychiatric manifestations. Atypical features of bipolar disorder including chronic mood instability, mixed episodes, and excitatory interepisodic symptoms were highlighted. During the neuropsychological evaluation, a dysexecutive profile consistent with frontal lobe pathology was evidenced. We hypothesized that the course and features of the illness were largely influenced by the presence of documented brain lesions compatible with endometrial implants, especially in the frontal region. Accordingly, patients with endometriosis who exhibit neurological as well as mental symptoms should be investigated for cerebral lesions.<\/jats:p>","DOI":"10.3390\/jcm11237212","type":"journal-article","created":{"date-parts":[[2022,12,5]],"date-time":"2022-12-05T06:29:09Z","timestamp":1670221749000},"page":"7212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Psychiatric Symptoms in Patients with Cerebral Endometriosis: A Case Report and Literature Review"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3865-7975","authenticated-orcid":false,"given":"Camilla","family":"Elefante","sequence":"first","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4460-0406","authenticated-orcid":false,"given":"Giulio Emilio","family":"Brancati","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elene","family":"Oragvelidze","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Tbilisi State Medical University, 0186 Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo","family":"Lattanzi","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Azienda Ospedaliero-Universitaria Pisana, 56126 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6324-0576","authenticated-orcid":false,"given":"Icro","family":"Maremmani","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"},{"name":"G. De Lisio Institute of Behavioral Sciences, 56127 Pisa, Italy"},{"name":"Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), 55045 Pietrasanta, Italy"},{"name":"Saint Camillus International University of Health and Medical Sciences (UniCamillus), 00131 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5556-1858","authenticated-orcid":false,"given":"Giulio","family":"Perugi","sequence":"additional","affiliation":[{"name":"Psychiatry Unit, Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy"},{"name":"G. De Lisio Institute of Behavioral Sciences, 56127 Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"745548","DOI":"10.3389\/fendo.2021.745548","article-title":"Pathogenesis Based Diagnosis and Treatment of Endometriosis","volume":"12","author":"Koninckx","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/S0015-0282(97)81904-8","article-title":"Changing trends in the diagnosis of endometriosis: A comparative study of women with pelvic endometriosis presenting with chronic pelvic pain or infertility","volume":"67","author":"Dmowski","year":"1997","journal-title":"Fertil. Steril."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2015.00019","DOI":"10.4293\/JSLS.2015.00019","article-title":"Endometriosis in adolescents","volume":"19","author":"Dun","year":"2015","journal-title":"JSLS J. Soc. Laparoendosc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/0002-9378(51)90180-9","article-title":"A clinical and surgical review of endometriosis","volume":"62","author":"Counseller","year":"1951","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1620\/tjem.210.175","article-title":"Management of the pain associated with endometriosis: An update of the painful problems","volume":"210","author":"Ozawa","year":"2006","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_6","first-page":"242149","article-title":"Endometriosis: A disease that remains enigmatic","volume":"2013","author":"Velasco","year":"2013","journal-title":"ISRN Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1067\/j.cpradiol.2011.01.003","article-title":"Beyond the boundaries-endometriosis: Typical and atypical locations","volume":"40","author":"Sonavane","year":"2011","journal-title":"Curr. Probl. Diagn. Radiol."},{"key":"ref_8","first-page":"335","article-title":"Endometriosis: Pathogenetic implications of the anatomic distribution","volume":"67","author":"Jenkins","year":"1986","journal-title":"Obstet Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1038\/nrurol.2017.58","article-title":"Pathophysiology and management of urinary tract endometriosis","volume":"14","author":"Nezhat","year":"2017","journal-title":"Nat. Rev. Urol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1186\/1746-1596-8-194","article-title":"Extrapelvic endometriosis: A rare entity or an under diagnosed condition?","volume":"8","author":"Machairiotis","year":"2013","journal-title":"Diagn. Pathol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1002\/ca.22617","article-title":"Neural involvement in endometriosis: Review of anatomic distribution and mechanisms","volume":"28","author":"Capek","year":"2015","journal-title":"Clin. Anat."},{"key":"ref_12","first-page":"361","article-title":"Extragenital Endometriosis in the Differential Diagnosis of Non-Gynecological Diseases","volume":"119","author":"Lukac","year":"2022","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ek, M., Roth, B., Ekstr\u00f6m, P., Valentin, L., Bengtsson, M., and Ohlsson, B. (2015). Gastrointestinal symptoms among endometriosis patients-A case-cohort study. BMC Womens Health, 15.","DOI":"10.1186\/s12905-015-0213-2"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"686","DOI":"10.1001\/jama.1983.03330300004002","article-title":"Neurological deficits, back pain tied to endometriosis","volume":"249","author":"Macek","year":"1983","journal-title":"JAMA"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/GRF.0000000000000292","article-title":"Medical Management of Endometriosis","volume":"60","author":"Rafique","year":"2017","journal-title":"Clin. Obstet. Gynecol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"304","DOI":"10.23736\/S2724-606X.21.04784-5","article-title":"Role of medical treatment of endometriosis","volume":"73","author":"Martone","year":"2021","journal-title":"Minerva Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1093\/humupd\/dmp007","article-title":"Recurrence of endometriosis and its control","volume":"15","author":"Guo","year":"2009","journal-title":"Hum. Reprod. Update"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.fertnstert.2017.05.004","article-title":"Reevaluating response and failure of medical treatment of endometriosis: A systematic review","volume":"108","author":"Becker","year":"2017","journal-title":"Fertil. Steril."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"264653","DOI":"10.1155\/2014\/264653","article-title":"Impact of medical and surgical treatment of endometriosis on the cure of endometriosis and pain","volume":"2014","author":"Mettler","year":"2014","journal-title":"BioMed Res. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/S0140-6736(21)00389-5","article-title":"Endometriosis is a chronic systemic disease: Clinical challenges and novel innovations","volume":"397","author":"Taylor","year":"2021","journal-title":"Lancet"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jpain.2015.09.008","article-title":"Functional Connectivity is Associated with Altered Brain Chemistry in Women With Endometriosis-Associated Chronic Pelvic Pain","volume":"17","author":"Kim","year":"2016","journal-title":"J. Pain"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.pain.2012.01.032","article-title":"Changes in regional gray matter volume in women with chronic pelvic pain: A voxel-based morphometry study","volume":"153","author":"Harris","year":"2012","journal-title":"Pain"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"100988","DOI":"10.1016\/j.yfrne.2022.100988","article-title":"Endometriosis, psychiatric comorbidities and neuroimaging: Estimating the odds of an endometriosis brain","volume":"65","author":"Maulitz","year":"2022","journal-title":"Front. Neuroendocrinol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"230","DOI":"10.1016\/j.ajog.2018.11.123","article-title":"Depressive symptoms among women with endometriosis: A systematic review and meta-analysis","volume":"220","author":"Gambadauro","year":"2019","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Carbone, M.G., Campo, G., Papaleo, E., Marazziti, D., and Maremmani, I. (2021). The Importance of a Multi-Disciplinary Approach to the Endometriotic Patients: The Relationship between Endometriosis and Psychic Vulnerability. J. Clin. Med., 10.","DOI":"10.3390\/jcm10081616"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/S0010-7824(01)00218-9","article-title":"A prospective study of the effects of oral contraceptives on sexuality and well-being and their relationship to discontinuation","volume":"64","author":"Sanders","year":"2001","journal-title":"Contraception"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1159\/000077739","article-title":"Drug-induced depression: A systematic review to inform clinical practice","volume":"73","author":"Patten","year":"2004","journal-title":"Psychother. Psychosom."},{"key":"ref_28","first-page":"786830","article-title":"Are Mood and Anxiety Disorders and Alexithymia Associated with Endometriosis?","volume":"2014","author":"Cavaggioni","year":"2014","journal-title":"A Prelim. Study"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jad.2020.03.047","article-title":"Risk of bipolar disorder in patients with endometriosis: A nationwide population-based cohort study","volume":"270","author":"Chen","year":"2020","journal-title":"J. Affect. Disord."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"415.e1","DOI":"10.1016\/j.ajog.2020.02.033","article-title":"Psychiatric comorbidity among women with endometriosis: Nationwide cohort study in Sweden","volume":"223","author":"Gao","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1141","DOI":"10.1016\/S1701-2163(16)35082-4","article-title":"Revisiting the Association Between Endometriosis and Bipolar Disorder","volume":"33","author":"Kumar","year":"2011","journal-title":"J. Obstet. Gynaecol. Canada"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1588","DOI":"10.1176\/ajp.144.12.1588","article-title":"Bipolar mood disorder and endometriosis: Preliminary findings","volume":"144","author":"Lewis","year":"1987","journal-title":"Am. J. Psychiatry"},{"key":"ref_33","first-page":"183","article-title":"Oligodendroglioma presenting as chronic mania","volume":"27","author":"Saha","year":"2015","journal-title":"Shanghai Arch. Psychiatry"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"273","DOI":"10.5498\/wjp.v5.i3.273","article-title":"Psychiatric aspects of brain tumors: A review","volume":"5","author":"Madhusoodanan","year":"2015","journal-title":"World J. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Wechsler, D. (2008). WAIS-IV: Wechsler Adult Intelligence Scale, Pearson. [4th ed.].","DOI":"10.1037\/t15169-000"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1027\/1015-5759\/a000306","article-title":"The Unitary Ability of IQ and Indexes in WAIS-IV","volume":"33","author":"Orsini","year":"2017","journal-title":"Eur. J. Psychol. Assess"},{"key":"ref_37","first-page":"19","article-title":"The GAI and CPI in the Italian standardization of the WAIS-IV and their clinical implications","volume":"276","author":"Pezzuti","year":"2016","journal-title":"Appl. Psychol. Bull."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1000","DOI":"10.1212\/WNL.45.5.1000","article-title":"Recurrent subarachnoid hemorrhage due to endometriosis","volume":"45","author":"Duke","year":"1995","journal-title":"Neurology"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"609","DOI":"10.3171\/jns.1987.66.4.0609","article-title":"Cerebral endometriosis. Case report","volume":"66","author":"Thibodeau","year":"1987","journal-title":"J. Neurosurg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2708","DOI":"10.1212\/WNL.43.12.2708","article-title":"A case of cerebral endometriosis causing catamenial epilepsy","volume":"43","author":"Ichida","year":"1993","journal-title":"Neurology"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.2214\/ajr.182.6.1821543","article-title":"Cerebellar endometriosis","volume":"182","author":"Sarma","year":"2004","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jmig.2010.09.002","article-title":"Resolution of catamenial epilepsy after goserelin therapy and oophorectomy: Case report of presumed cerebral endometriosis","volume":"18","author":"Vilos","year":"2011","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1080\/09513590.2018.1463362","article-title":"Complete remission of cerebral endometriosis with dienogest: A case report","volume":"34","author":"Maniglio","year":"2018","journal-title":"Gynecol. Endocrinol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1055\/s-0040-1701622","article-title":"Case Report of Cerebellar Endometriosis","volume":"81","author":"Meggyesy","year":"2020","journal-title":"J. Neurol. Surg. A Cent. Eur. Neurosurg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1177\/2284026520966504","article-title":"A surgical solution for a catamenial epilepsy medical therapy-resistant: A presumed case of cerebral endometriosis?","volume":"13","author":"Antonio","year":"2021","journal-title":"J. Endometr. Pelvic. Pain Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/bdi.12387","article-title":"Mania secondary to focal brain lesions: Implications for understanding the functional neuroanatomy of bipolar disorder","volume":"18","author":"Satzer","year":"2016","journal-title":"Bipolar. Disord."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1001\/archneur.1993.00540080076020","article-title":"Frontal-Subcortical Circuits and Human Behavior","volume":"50","author":"Cummings","year":"1993","journal-title":"Arch. Neurol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1038\/s41398-020-0811-0","article-title":"Right-sided brain lesions predominate among patients with lesional mania: Evidence from a systematic review and pooled lesion analysis","volume":"10","author":"Cotovio","year":"2020","journal-title":"Transl. Psychiatry"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1080\/0269905031000070170","article-title":"Rapid cycling bipolar disorder after left temporal polar damage","volume":"17","author":"Murai","year":"2003","journal-title":"Brain Inj."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1176\/ajp.140.9.1197","article-title":"Mania secondary to left and right hemisphere damage","volume":"140","author":"Jampala","year":"1983","journal-title":"Am. J. Psychiatry"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Elefante, C., Brancati, G.E., Torrigiani, S., Amadori, S., Ricciardulli, S., Pistolesi, G., Lattanzi, L., and Perugi, G. (Curr. Neuropharmacol., 2022). Bipolar Disorder and Manic-like Symptoms in Alzheimer\u2019s, Vascular and Frontotemporal Dementia: A Systematic Review, Curr. Neuropharmacol., online ahead of print.","DOI":"10.2174\/1570159X20666220706110157"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7212\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:33:55Z","timestamp":1760146435000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/23\/7212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,4]]},"references-count":52,"journal-issue":{"issue":"23","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11237212"],"URL":"https:\/\/doi.org\/10.3390\/jcm11237212","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,4]]}}}