Resolution of bipolar II and panic disorders following subarachnoid hemorrhage

Poststroke Psychosis Reduction: A Case Report

Strokes have been shown to result in psychiatric phenomena that can range from mood disorders to psychosis. Ablative neurosurgeries have been performed with the goal of reducing the burden of psychiatric symptoms following such cerebrovascular accidents. In this report, we review poststroke psychiatric manifestations, and then present the case of a woman with schizophrenia whose thought disorder improved following a hemorrhagic stroke. Not only did she require less medication, but her remaining symptoms were significantly less impairing than they had previously been. We then compare and contrast the effects of this stroke with ablative neurosurgery.

Mania and stroke: a systematic review

BACKGROUND

Mania is a rare consequence of stroke and according to the sparse published information it is difficult to describe its demographic, clinical and prognostic characteristics.

METHODS

We performed a systematic review of all cases of mania and stroke to describe those characteristics. Studies were identified from comprehensive searches of electronic databases, reference lists of the studies collected and handbooks. Two authors independently assessed abstracts, and collected and extracted data.

RESULTS

From 265 abstracts, 139 were potentially relevant. For the first analysis, which tries to answer the clinical question of the relationship between mania and stroke, 49 studies met the inclusion criteria and described 74 cases. For the second analysis, we looked for an explicit temporal and causal relationship between manic symptoms and stroke, and selected 32 studies describing 49 cases. In both analyses, the typical patient was male, without a personal or family history of psychiatric disorder, with at least one vascular risk factor, but without subcortical atrophy and had suffered a right cerebral infarct. The majority of patients (92%) presented elevated mood as the first symptom. The other frequent symptoms were an increased rate or amount of speech (71%), insomnia (69%) and agitation (63%).

CONCLUSIONS

Post-stroke mania should be considered in any manic patient who presents concomitant neurological focal deficits and is older than expected for the onset of primary mania. The results of a systematic study of mania in acute stroke with subsequent follow-up and data from diffusion MR or perfusion CT in a multicenter study with a central database would be relevant.