A 21-year-old male presented with acute onset of bizarre behavior, flight of ideas, and disorganized speech. Notable history includes that the patient’s father likely has schizophrenia. His neurological exam showed normal cranial nerve, sensory, and motor function. His reflexes were normoactive throughout with flexion plantar responses bilaterally. He exhibited delusional behavior consistent with Capgras syndrome such as believing that his parents were not his actual parents but other people downloaded into them. Throughout his 2-month hospitalization he was tried on multiple psychiatric medications such as Haldol, Risperidone, Trileptal, and Depakote without significant improvement. Basic lab-work with CBC, CMP, and TSH was unremarkable. His UDS was positive for THC. MRI brain with contrast showed a 3.1 x 2.7 cm mass in the right temporal fossa with invasion of the clivus and destruction of the anterior sphenoid process. Routine EEG was unremarkable. The mass was biopsied and most consistent with a chondrosarcoma. He was eventually discharged to a nursing home with further workup and treatment to be done outpatient.

This case illustrates a patient with Capgras syndrome and a chondrosarcoma compressing the right temporal lobe. While our patient may have underlying schizophrenia, the fact that he did not respond to multiple medications over his 2-month hospitalization suggests that the mass compressing the right temporal lobe was contributing to his Capgras syndrome.