J Neuropsychiatry Clin Neurosci 1990; 2:322-325
Copyright © 1990 by American Neuropsychiatric Association
Secondary mania after ventral pontine infarction
ME Drake Jr, A Pakalnis and B Phillips
Department of Neurology, Ohio State University Hospitals and College of Medicine, Columbus.
Secondary mania is increasingly recognized clinically, and consists of
acute exhibition of manic symptoms without past or family history of
affective disorder. It has been reported with toxic and metabolic
disturbances, primary and metastatic brain tumors, epilepsy, and
cerebrovascular events. A multifactorial etiology has been suggested. We
report two men, 52 and 56 years old, who developed grandiosity,
sleeplessness, irritable mood, hyperactivity, and paranoid and religious
delusions, with attempted violence in one case. Both had no premorbid
psychiatric history and were healthy except for hypertension. One patient
had a normal neurologic examination, and the other had mild left
hemiparesis and hyperreflexia. EEGs, brainstem auditory-evoked responses,
and median nerve somatosensory-evoked potentials were normal. Magnetic
resonance studies demonstrated infarction of the ventral pons (on the right
in the patient with left-sided signs and on the left in the patient with
normal neurologic examination). The two patients responded to lithium
carbonate and neuroleptics and have not had further psychiatric symptoms in
18 months of follow-up. These cases emphasize the relationship of
late-onset mania with predisposing brain disease, and they suggest that
brainstem disturbances can influence mood, sleep, libido, and thought.
