The authors describe 9 patients with bipolar affective disorder
associated with cerebrovascular lesions. Eight had negative family
histories of affective disorders and late age at onset (after age 40) of
manic-depressive symptoms. Only one, with positive family history of
affective disorders, developed mood swings before age 40. Clinical subtypes
of bipolar disorder and patterns of affective cycling in these stroke
patients resembled those previously reported in functional bipolar
disorder. Five patients had concurrent hyperkinetic movement disorders, and
one depressed patient presented with unilateral left- sided parkinsonism
that disappeared during a manic switch. In most patients, bipolar affective
disorder was associated with right hemisphere lesions that involved
subcortical and midline structures. Findings suggest that damage to
frontal-basal ganglia-thalamocortical circuits by subcortical vascular
lesions may simultaneously provoke disorders of movement and mood
regulation.Abstract Teaser