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Multiple meningioma often can be clinically silent and may present with only psychiatric symptoms. We report a case of 43-year-old, right handed woman with a 23 year history of long standing bipolar affective disorder, who presented with a mixed episode with psychotic symptoms which did not respond to usual treatment and was further complicated with a different set of symptomatology. MRI brain revealed multiple dural based mass lesions identified to be multiple meningiomas. Patient’s symptoms improved after gamma knife stereotactic radiosurgery for the multiple meningioma. Our finding illustrates the need to assess for brain lesions in presence of atypical symptoms, along with unresponsiveness to traditional management with psychotropic medications in patients with bipolar affective disorders.

Flouroquinolones are widely used antibiotics with side effects that involve the central nervous system. Here, we are presenting the case of a patient who developed hypomania after taking ofloxacin. The clinical features included an elevated mood, increased talkativeness, a decreased need for sleep, and drawing up big plans. The episode was circumscribed and resolved after the discontinuation of the antibiotic.