Depression and possible dementia masked the real problem


(Owen Freeman For The Washington Post)
December 23, 2013

Bebe Bahnsen remembers the night, alone in her small cottage on the Alabama coast, that she felt a strong urge to drink a can of drain cleaner.

For years, antidepressants combined with talk therapy had enabled Bahnsen, whose first name is Beatrice, to function well, establishing a thriving public relations business in Washington followed by a career as a newspaper reporter. But those days had been supplanted by a prolonged suicidal depression that had proved impervious to electroshock treatments, periodic hospitalizations and a raft of psychiatric drugs. The phone call in which Bahnsen confided her desire to drink poison seemed to confirm the worst fears of one of her closest friends.

“I figured, well, she was one of those people who just was not ever going to get better,” said Paddy Bowman, a folklore specialist who lives in Alexandria.

Bahnsen, now 73, traces the beginning of her psychological slide to the mid-1990s, when she decided that, after two decades, she’d had enough of Washington. She moved back to her home state of Georgia and her life slowly began to unravel. She felt estranged from her large and devoted circle of friends, began having problems at work, and grew restless and increasingly depressed.

“I felt as though I was on a large island and everyone was slowly moving away and I was there by myself,” Bahnsen recalled. For the first time in her life, she said, she was intermittently psychotic. Periodic suicide attempts, some involving overdoses of prescribed sleeping pills, landed her in a series of mental hospitals.

In November 2006 she was hospitalized in Las Vegas, where she was then living with one of her sons. Doctors, baffled by her longstanding failure to improve, decided to take a closer look at her case. What they found resulted in an entirely different treatment, one that had a rapid and dramatic effect on her mental state.

Neurologist Dariusz Gawronski, who treated Bahnsen, said her case remains one of the most memorable of his 20-year career.

“It’s very rare in this country to see this,” said Gawronski, who attended medical school in his native Poland before finishing his training in the United States. “It does make you wonder why there was [such] inattention prior to her deterioration.”

Better after Prozac — at first

Bahnsen, who had endured a difficult childhood, was open with her friends about her struggle with depression. Until her move to Atlanta when she was in her mid-50s, she had never been hospitalized: Psychotherapy and antidepressants, especially Prozac, had been effective.

“Bebe had this really rich, interesting life,” said Bowman, her close friend since the 1970s. When she moved to Atlanta, Bahnsen quickly found work as a reporter at the Atlanta Journal-Constitution, a job she liked.

Restless and increasingly dissatisfied after a few years, Bahnsen moved to Sarasota, Fla., then to Pensacola and after that to Alabama, propelled by forces she did not understand. Each time, she remembers thinking that a move might be therapeutic — a fresh start.

“But I found it harder and harder to talk to people, and I was more depressed and more distant,” she recalled.

Bowman said she and other friends watched helplessly, unsure about what was fueling Bahnsen’s peripatetic existence and alarmed by her rambling, sometimes incoherent conversations. “She started being kind of paranoid about people at work, fixating on one woman to whom she ascribed ‘evil intent,’ ” Bowman said. “At times she seemed psychotic.”

“Friends started dropping her, saying, ‘She’s too crazy, I can’t deal with it,’ ” Bowman recalled. “She wore everybody out.”

In March 2002, while hospitalized in Mobile because of suicidal thoughts including her desire to drink drain cleaner, a doctor ordered an MRI scan of her brain. Bahnsen said she is not sure why the test was ordered, but she believes it was because the psychiatrist could not figure out why more than a dozen drugs she had taken in various combinations over the years had not alleviated her psychotic depression.

The MRI showed a small meningioma. One of the most common brain tumors — it is diagnosed in 6,500 Americans annually — meningiomas are typically benign. Depending on their location, they may cause no symptoms; many are discovered incidentally during a brain scan performed for another reason. Such tumors, which have been linked to exposure to radiation including from dental X-rays, often grow slowly.

Bahnsen remembers feeling terrified by the news she had a brain tumor. She said she asked the neurologist whether the mass might have something to do with her depression.

“I vividly remember he told me emphatically that had nothing to do with it,” she recalled. “He said, ‘It’s small, benign and don’t worry about it.’ So I didn’t.”

Bowman remembers Bahnsen calling her about the diagnosis and feeling disappointed it wasn’t the reason for her friend’s worsening mental illness. “I had never heard of a meningioma,” she said, “but the doctor said nothing needed to be done.”

Soon afterward, Bahnsen moved to Arizona to live with one of her sons, an arrangement that lasted only a few months. She moved back to Georgia, sometimes staying with friends or renting a short-term apartment.

“I struggled to eke out a living,” she said. Too disabled to work as a reporter, she cobbled together freelance writing jobs. In 2005 she underwent a series of eight electroshock treatments at an Atlanta psychiatric hospital, hoping they would jolt her out of her depression. The sessions, which resulted in memory loss, did little to relieve the blackness that had engulfed her.

The following year, she moved to Las Vegas to live with her other son.

“It’s just extremely difficult to express how horrible my depression had become,” Bahnsen said, adding that she was aware of becoming “more and more batty. I had never experienced anything like it.”

She was also terrified that her cognitive ability was slipping. She was having trouble expressing herself and feared she was developing dementia, even though she was barely 66.

Around Thanksgiving 2006, a serious suicide attempt landed her in a Las Vegas hospital. By now, she said, she also was falling, although doctors weren’t sure why.

While hospitalized, doctors took her off all medication, a technique known as a washout, to see if some of her symptoms might be drug-related. Seeing no improvement, Gawronski was called in as a neurological consultant to assess her for dementia.

Just in time

Gawronski, who now practices in Baton Rouge, remembers that Bahnsen was confused and not very alert; she spoke but could not formulate questions.

He ordered a brain MRI and quickly discovered the probable reason for her dementia: the meningioma, roughly the size of a peanut when it was discovered four years earlier, had grown to the size of a lime. The tumor was pressing on her left frontal lobe, the portion of the brain responsible for speech, movement, emotional regulation and reasoning.

Most alarming was the evidence of “mass effect”: The tumor appeared to be exacerbating her previously manageable depression, causing personality and mood changes. Doctors were most worried about herniation, an often fatal condition that occurs when the brain is squeezed and shifts out of position.

“She was deteriorating,” Gawronski recalled, “and if the downward pressure from the tumor increased, she could have lapsed into a coma.” Gawronski estimated that Bahnsen was “possibly days away from that.”

On Dec. 4, 2006, Bahnsen underwent an emergency operation to remove the benign meningioma. Days after surgery, she began feeling like herself again, although her memory of the preceding year remains hazy.

“I felt like I had my mind back,” she recalled. “It was the most amazing feeling.”

Bowman, who had learned about the surgery from Bahnsen’s son, was astonished by how transformed her friend sounded when Bahnsen called her a few weeks later.

“I thought, ‘Oh, my God, it’s you,’ ” Bowman remembers thinking. “It was like the old Bebe was back. I wish I had done some research after she told me about the meningioma the first time, but I believed that doctor, which is something I’ll always regret.”

Bahnsen said she does not remember that the neurologist who discovered the tumor in 2002 told her it needed to be monitored regularly, which is standard medical advice. And because he insisted that it was unrelated to her worsening depression, she did not think to mention it to doctors she saw subsequently.

After several weeks in the hospital, Bahnsen spent about a month in a rehab facility. On Feb. 27, 2007, the neurosurgeon who operated on her wrote that “she has made a remarkable recovery. She went from being completely unresponsive to a walking, talking normal human being again.”

Gawronksi said that even a meningioma that doesn’t cause problems should be tracked with regular brain scans. If it becomes too large or its location is problematic, surgery to remove it is often recommended.

Gawronski said he suspects that Bahnsen’s frequent moves may have led to “the continuity of care being fractured.”

Tumor redux

In 2007, Bahnsen returned to Georgia and has lived there since.

Last year, she underwent a second operation to remove a new meningioma. Smaller than the first, it was classified as atypical, meaning it is more likely to be cancerous if it recurs.

This second surgery involved a harrowing complication: Bahnsen developed a serious postoperative infection that required two additional operations, which left part of her face collapsed.

Bahnsen said she tries not to worry about what might happen in the future; most days she feels fine physically and cherishes her close relationships. She has begun writing again, and doesn’t like to dwell on the what-ifs — such as what if her tumor had been discovered sooner, sparing her years of misery and disability?

“When I think about that, I get extremely angry,” she said. “Luckily, it was so wonderful that Dr. Gawronski knew what to do.”

Submit your solved medical mystery to medicalmysteries@washpost.com. Read previous mysteries at wapo.st/17qgykw .

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