Post-stroke mania in late life due to right temporoparietal infarction (original) (raw)

Acute Psychiatric Manifestations of Stroke: A Clinical Case Conference

Psychosomatics, 2003

C erebrovascular accidents are common and debilitating medical events that frequently result in significant functional impairment and medical comorbidity. Further, they are associated with substantial emotional and behavioral sequelae that significantly exacerbate such disability. Due to the high rates of psychiatric sequelae of stroke, the general hospital psychiatrist is frequently called on to evaluate and treat poststroke patients.

Cerebellar Stroke-manifesting as Mania

Indian Journal of Psychological Medicine, 2014

occupation presented to our outpatient department (OPD) on 05.05.2008 with acute excitement and inability to walk. Although working in the fields the previous day, he had a feeling of giddiness and had projectile vomiting. He was feeling dazed and uneasy and lied down for next 60 min. Subsequently, he noticed that he could not walk. He noticed a change in his speech. He started talking excessively and was quarrelling with others. He could not sleep on the day of onset of his complaints. Throughout the night he was disturbing others and demanding things. He was brought to the OPD next morning. On examination, he was noted to be asthenic built. His psychomotor activity was accelerated. He was talking spontaneously and excessively to everyone as if they were familiar to him. His mood was euphoric with irritability at times. He was expressing grandiose ideas that he has a lot of power and can even beat 500 men. Hallucinations could not be elicited. He was distracted by events happening around him. He was well oriented. His recent memory was normal and he described his onset of illness very lucidly. He lacked insight to his mental illness, but accepted his walking difficulty and said he wants medical attention. Secondary mania resulting from cerebral Cortex are described commonly. But secondary mania produced by cerebellar lesions are relatively uncommon. This case report describes a patient who developed cerebellar stoke and manic features simultaneously. 28 years old male developed giddiness and projectile vomiting. Then he would lie down for about an hour only to find that he could not walk. He became quarrelsome. His Psycho motor activities and speech were increased. He was euphoric and was expressing grandiose ideas. Bender Gestalt Test showed signs of organicity. Score in Young mania relating scale was 32; productivity was low in Rorschach. Neurological examination revealed left cerebellar signs like ataxia and slurring of speech. Computed tomography of brain showed left cerebellar infarct. Relationship between Psychiatric manifestations and cerebellar lesion are discussed.

Post-Stroke Mania: A Case Series in A Rural, Community Hospital

2020

Background and Purpose: Post-stroke mania is thought to be rare, and has been described after lesions in the territory of the left medial cerebral artery, biparietal cortex, and the left putamen. Methods: Case-study methodology was used to identify similarities and difference among six cases of post-stroke mania in a rural, community hospital over 1 year. Results: All patients had pre-existing moderate levels of small vessel occlusive disease and two had confirmed lacunar infarcts in the basal ganglia, while one had a small left sided fronto-parietal infarct consistent with the dysarthria-clumsy hand syndrome. Stroke was not initially recognized among these patients due to the absence of acute Computed Tomography (CT) findings. Patients without pre-existing psychiatric diagnoses responded to low dose quetiapine. Two patients with pre-existing diagnoses of depression and anxiety, required higher doses. Conclusion: Post-stroke mania may be under-appreciated due to the subtle neurological findings inherent to basal ganglia and/or lacunar infarcts in other locations. Acute CT is not reliable enough to confirm the diagnosis of stroke which may allow many of these cases to be missed.

Secondary mania of vascular origin in elderly patients: A report of two clinical cases

Archives of Gerontology and Geriatrics, 2006

The concept of secondary mania continues to be debated together with unresolved or partially resolved issues such as lateralization, localization, age of onset, disinhibition syndromes, and others. We have described two patients with secondary mania following a stroke. One had a large left hemisphere cerebral infarction and the symptoms arose about 2.5 years later, possibly triggered by a transient ischemic attack involving the right hemisphere. The other had an infarction in the right posterior artery territory extending to the thalamus and internal capsule together with infarctions in the deep border zones of both hemispheres at the level of the centrum semiovale with the manic symptoms concomitant with the onset of the event. The clinical and neuro-anatomic mechanisms that underlie the diverse locations of secondary mania are discussed. The cerebral components of secondary mania and disinhibition syndromes are very similar and it is proposed that disinhibition syndromes, secondary hypomania and secondary mania with and without psychotic symptoms are simply a continuum of severity of mood disorder and secondary mania with psychotic symptoms may be an extreme form. The concept of secondary mania in the elderly is not likely to disappear although several unresolved issues remain. For the neurophysician, geriatrician, and the psychiatrist there is much to be attained by simplifying the issues and accepting the view that secondary mania is a discrete entity. #

A Brief Psychotic Episode with Depressive Symptoms in Silent Right Frontal Lobe Infarct

Korean journal of family medicine, 2017

Psychiatric symptoms may be related to a silent cerebral infarct, a phenomenon that has been described previously in literature. Acute psychosis or other neuropsychiatric symptoms including depression may present in stroke patients and patients with lesions either within the prefrontal or occipital cortices, or in subcortical areas such as the basal ganglia, thalamus, mid-brain, and brainstem. Psychosis in clinical stroke or in silent cerebral infarction is uncommon and not well documented in the literature. Neurological deficits are the most common presentation in stroke, and nearly a third of patients that suffer a stroke may experience psychological disorders such as depression and anxiety, related to physical disability. The present case report describes an elderly female patient who presented with hallucinations and depressive symptoms, and was discovered to have a recent right frontal brain infarction, without other significant neurological deficits.

Neuropsychology of acute stroke

Psychiatria Danubina, 2010

Neuropsychology includes both the psychiatric manifestations of neurological illness (primary brain-based disorders) and neurobiology of "idiopathic" psychiatric disorders. Neurological primary brain disorders provoke broad spectrum of brain pathophysiology that cause deficit sin human behaviour, and the magnitude of neurobehavioral-related problems is a world wide health concern. Speech disorders of aphasic type, unilateral neglect, anosognosia (deficit disorders), delirium and mood disorders (productive disorders) in urgent neurology, first of all in acute phase of stroke are more frequent disorders then it verified in routine exam, not only in the developed and large neurological departments. Aphasia is common consequence of left hemispheric lesion and most common neuropsychological consequence of stroke, with prevalence of one third of all stroke patients in acute phase although exist reports on greater frequency. Unilateral neglect is a disorder that mostly effects th...

Case Reports Depression and Dementia of Cerebrovascular Origin

2002

We report the case of a patient who presented various psychiatric syndromes at the time of evaluation – partial complex epileptic seizures, personality change, and severe depression, which eventually progressed to dementia – resulting from multiple cerebral infarctions of probable neuro-angiopathic origin, of unknown etiology. Aspects related to depression following cerebrovascular accidents, as well as how cerebrovascular accidents can result in different disorders depending on the variables, are discussed based on the data from current literature.