Poststroke manic symptoms: an unusual neuropsychiatric condition

Rocha, Felipe Filardi da; Carneiro, Juliana Garcia; Pereira, Pedro Paulo; Corrêa, Humberto; Teixeira, Antônio Lúcio

doi:10.1590/s1516-44462008000200020

Cited by 5 publications

(1 citation statement)

References 3 publications

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“…The majority of the studies were case reports (71%) [7,8,17,19,20,21,22,23,24,25,27,28,29,30,32,33,34,35,36,37,38,39,40,41,43,44,45,46,47,48,49,56,57,58,60], followed by case series (14%) [16,18,26,31,51,53,54] and cohort studies (8%) [12,42,52,61]. The fact that case reports are usually shorter descriptions explains the lack of information we found when we tried to assess other parameters of the diagnosis and assessment.…”

Section: Resultsmentioning

confidence: 99%

Mania and Stroke: A Systematic Review

Santos

Caeiro

Ferro³

et al. 2011

Cerebrovasc Dis

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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.

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Section: Resultsmentioning

confidence: 99%

Mania and Stroke: A Systematic Review

Santos

Caeiro

Ferro³

et al. 2011

Cerebrovasc Dis

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Mania

Santos¹,

Caeiro²,

Ferro³

2013

Neuropsychiatric Symptoms of Neurological Disease

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Diverse pathophysiological processes converge on network disruption in mania

Lee

Nielsen

Nawaz

et al. 2019

Journal of Affective Disorders

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Background: Neuroimaging of psychiatric disease is challenged by the difficulty of establishing the causal role of neuroimaging abnormalities. Lesions that cause mania present a unique opportunity to understand how brain network disruption may cause mania in both lesions and in bipolar disorder. Methods: A literature search revealed 23 case reports with imaged lesions that caused mania in patients without history of bipolar disorder. We traced these lesions and examined resting-state functional Magnetic Resonance Imaging (rsfMRI) connectivity to these lesions and control lesions to find networks that would be disrupted specifically by mania-causing lesions. The results were then used as regions-of-interest to examine rsfMRI connectivity in patients with bipolar disorder (n=16) who underwent imaging longitudinally across states of both mania and euthymia alongside a cohort of healthy participants scanned longitudinally. We then sought to replicate these results in independent cohorts of manic (n=26) and euthymic (n=21) participants with bipolar disorder. Results: Mania-inducing lesions overlap significantly in network connectivity. Mania-causing lesions selectively disrupt networks that include orbitofrontal cortex, dorsolateral prefrontal cortex, and temporal lobes. In bipolar disorder, the manic state was reflected in strong, significant, and specific disruption in network communication between these regions and regions implicated in bipolar pathophysiology: the amygdala and ventro-lateral prefrontal cortex. Limitations: There was heterogeneity in the clinical characterization of mania causing lesions. Conclusions: Lesions causing mania demonstrate shared and specific network disruptions. These disruptions are also observed in bipolar mania and suggest a convergence of multiple disorders on shared circuit dysfunction to cause mania.

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Poststroke manic symptoms: an unusual neuropsychiatric condition

Cited by 5 publications

References 3 publications

Mania and Stroke: A Systematic Review

Mania and Stroke: A Systematic Review

Mania

Diverse pathophysiological processes converge on network disruption in mania

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