Changes in Painting Style by Poststroke Mania

Abstract

Letter to the EditorDear Sir:Post stroke neuropsychiatric syndrome is common.1 Many patients after stroke experience depression, cognitive impairment, personality change, psychosis, apathy, and anxiety. Mania can also be a consequence of stroke but is not common.2 "Mania" is described as a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week in the Diagnostic and Statistical Manual of Mental Disorder-V.3 Mania seems to be observed more frequently with the right side brain lesions. 4 Here, we report a professional artist whose painting style dramatically changed with manic illness from a recent stroke. Informed consent for this report was obtained.A 58-year-old Korean man who had worked in Russia as a professional painter visited the emergency room due to a sudden onset of dysarthria and left side weakness, which were noted when he woke up in the morning. He did not have any other vascular risk factors except for smoking. On neurologic examination, dysarthria, left facial palsy and left hemiparesis (motor grade IV/IV) were observed. Left side sensory change and sensory extinction were noted, but prosopagnosia was not observed. With ophthalmologic examination, corrected visual acuity was 0.8/0.8 on near card test, visual field defect was not observed on manual test and achromatognosia was not noted. The brain magnetic resonance imaging revealed a territorial ischemic lesion with proximal occlusion of the inferior division of the right middle cerebral artery ( Figure 1A). Cardioembolic source was not found on the transthoracic echocardiogram, transesophageal echocardiogram and holter monitoring. An antiplatelet drug and statin were prescribed.When he visited our outpatient clinic 2 weeks after the symptom onset, although his neurological deficits were much improved, he became very erratic, aggressive, talkative, hyperenergetic, and lost the desire to sleep with an increased goal directed activities such as staying up all night and continuously drawing art pieces consisting of a human face. Furthermore, his wife noted that his style of painting was absolutely transformed. We compared the paintings he drew after his stroke with some of his paintings from Russia on his website before the stroke ( Figure 1B, C). His previous artwork showed complementary and subtle color schemes, with well-defined heads and figures using sharp lines. The paintings were ordered with an austere simplicity. On the other hands, his new artwork showed a drastic change in the artistic style. The drawings are complex, disrupted and disorganized with splattering of words and phrases (in more than one language). Use of color became broader and more overt.After starting carbamazepine 100 mg twice daily as a mood stabilizer, his mood slightly improved; however, he was still talkative, and his paintings were still awkward, complex and disorganized.Here, we reported the case of a professional painter who showed changes in his artistic style and behavior after an ischemic stroke. There have be...

Non-invasive Brain Stimulation and Prism Adaptation in Art Constructive Errors in Painting

“…Findings regarding the classification of constructive errors in paining showed that omission errors were most common in patients with stroke-inducted neglect. Omission error outcome was consistent with studies on professional artists (Bäzner & Hennerici, 2006;Blanke & Pasqualini, 2012;Rhee et al, 2016). Right-hemisphere stroke patients showed mostly left space omission errors and changes in painting style (J.-M. H. H.…”

“…However, there is limited research into therapy for adults with acquired art constructive errors in painting. Previous studies on the art constructive errors of painting were focused on after stroke effects in professional painters (Pachalska et al, 2008;Rhee et al, 2016). Although patients in our study were not professional painters, they presented errors in the painting like professional painters after stroke.…”

“…Right-hemisphere stroke patients showed mostly left space omission errors and changes in painting style (J.-M. H. H. Bäzner & M. G. Hennerici, 2007;Mazzucchi et al, 2013;Rhee et al, 2016). In contrast, left-hemisphere stroke patients showed painting without omission (Mazzucchi et al, 2013).…”

“…Injury to the right hemisphere of the brain often associated with the neurological disability of function and neglect-induced cognitive impairment in drawing, coloring, and copying is known as art constructive errors of painting (Rhee, Hong, Kim, & Lee, 2016;Rode, Pagliari, Huchon, Rossetti, & Pisella, 2017). Art constructive errors are among the spatial disorders of painting and commonly include missing elements, omission errors, and change in size error, visuospatial destruction mistake, and neglect of warm colors fault.…”

Poststroke mania

“…По данным метаанализа [8], самыми частыми симптомами постинсультной ма-нии были повышенное настроение (91%), патологи-ческая говорливость (71%), сниженная потребность во сне (69%), ажитация (63%). Описан случай изме-нения стиля рисования у художника с симптомами мании после инсульта в системе средней мозговой артерии [31]. Метаанализ позволил выявить наибо-лее характерные особенности пациентов с постин-сультной манией.…”