Post-stroke emotional incontinence or bipolar disorder?

Abstract

IntroductionPost-stroke emotional incontinence and bipolar disorder are two disorders that involve the dysfunction of brain structures responsible for emotional regulation. The objective of this work is to study the links between these disorders through a clinical case.Case reportWe present the case of a 43-year-old man without previous psychiatric history who experienced emotional incontinence after cerebrovascular events. He reacted promptly to selective serotonin reuptake inhibitor treatment. However, he experienced his first episode of hypomania after 6 months of antidepressant therapy. Adjunctive therapy with valproic acid and low-dose paroxetine was eventually added, resulting in complete improvement of both emotional incontinence and hypomania after 4 additional months of treatment.ConclusionThe clinician should carefully explore any history of premorbid bipolar disorder, personality disorder characterized by mood instability, and family history of bipolar disorder.

Assessment of poststroke mania and diagnosis

“… 1 This case report also mentions development of treatment response to selective serotonin reuptake inhibitors, which also shows that poststroke emotional incontinence is related predominantly to serotonergic system dysfunction. 2 …”

“… 5 In this case, magnetic resonance imaging showed right-sided stroke and the presence of multiple acute lacunar infarcts of lenticulocapsular and right semiovale regions. 2 …”