J Neuropsychiatry Clin Neurosci 1996; 8:160-167
Copyright © 1996 by American Neuropsychiatric Association
Poststroke bipolar affective disorder: clinical subtypes, concurrent movement disorders, and anatomical correlates
ML Berthier, J Kulisevsky, A Gironell and JA Fernandez Benitez
Neurology Service and the Psychiatry Service, Virgen de la Victoria University Hospital, Malaga, Spain.
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.
