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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Increasing evidence indicates that subtypes of bipolar disorder differ not only in symptomatology and associated clinical features, but by differences in age at onset, illness course, and response to treatment. Secondary manic states differ from typical bipolar states and are often especially difficult to treat. Although the correction of the underlying organic factors (toxic, metabolic, or infectious) may effectively reverse the manic presentation, many organic factors are not reversible (trauma, stroke, and aging), and the presence of these etiologic factors can complicate traditional antimanic treatments. Lithium may be effective for treating patients with secondary mania, but data from published studies show that in this population the associated adverse effects often limit its usefulness. Anticonvulsants appear to offer an effective alternative. Divalproex sodium, in particular, has been shown to be an effective and well-tolerated treatment in open trials in the elderly and other patient groups with secondary mania. Controlled clinical trials are necessary to confirm the efficacy and tolerability of mood-stabilizing anticonvulsants in the treatment of secondary mania.
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PMID:Secondary mania: diagnosis and treatment. 1124 98

Numerous emotional and behavioral disorders occur following cerebrovascular lesions. Depression is the most common of these, affecting up to 40% of patients. Clinical correlates of post-stroke depression include severity of physical and cognitive impairment as well as location of brain injury. Perhaps the most compelling reason to identify post-stroke depression, however, is its substantial impact on recovery in activities of daily living, cognitive function, and survival. Antidepressant medication has been shown to effectively treat depression, although its administration may require careful clinical monitoring. Other post-stroke emotional/behavioral disorders include mania, bipolar disorder, anxiety disorder, apathy, and pathological crying. Controlled studies have not documented the effect of these disorders on long-term recovery, but the potential impact of syndromes such as mania and apathy on rehabilitation efforts or pathological crying on social functioning are evident. With the exception of pathological crying, which has been shown to respond to antidepressant drug therapy, the other post-stroke emotional/behavioral disorders need to be evaluated in controlled treatment trials for response to therapy.
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PMID:Neuropsychiatric consequences of stroke. 904 57

Disinhibition syndromes, ranging from mildly inappropriate social behavior to full blown mania, may result from lesions to specific brain areas. Several studies in patients with closed head injuries, brain tumors, stroke lesions, and focal epilepsy have demonstrated a significant association between disinhibition syndromes and dysfunction of orbitofrontal and basotemporal cortices of the right hemisphere. Based on the phylogenetic origin of these cortical areas and their main connections with dorsal regions related to visuospatial functions, somatosensation, and spatial memory, the orbitofrontal and basotemporal cortices may selectively inhibit or release motor, instinctive, affective, and intellectual behaviors elaborated in the dorsal cortex. Thus, dysfunction of these heteromodal ventral brain areas may result in disinhibited behaviors.
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PMID:Mechanism of disinhibition after brain lesions. 904 3

To study factors associated with different mood disorders in old age, researchers need clear and meaningful definitions. "Major depression" is too broad and heterogeneous a category, and the boundaries of "dysthymia" are ill-defined, yet epidemiologic studies have focused on these disorders. Depressions in old age are commonly associated with medical conditions; prevalence rates of depression in cases of stroke, Parkinson's disease, dementia, and disabilities (all much commoner in old age) range upward from about 20%. Depressions are attributed to both psychological and biological reactions. Mania, too, can be precipitated by cerebral and other medical factors. The proportion of psychiatric inpatients who have depressions with melancholic and/or psychotic features is higher among elderly subjects, and this has been linked with white matter lesions and other brain changes that become commoner in old age. The prognostic relevance of these brain changes, and implications for treatment of mood disorders, require clarification.
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PMID:Epidemiologic questions on mood disorders in old age. 905 16

Numerous studies in stroke patients suggest that the left frontal anterior region may be strategic for depression. However, these findings could not always be replicated. Some authors even deny any etiological contribution of lesion location to depression. The predominant role of the right hemisphere in secondary mania is well recognized. In disorders such as apathy, anxiety, catastrophe reactions and pathological laughing and crying, further studies are needed to determine the potential clinico-topographic correlations. Affective disorders are important to consider in stroke patients, since they may influence neurological recovery and may be responsive to treatment. Remarkable features of emotional behavior, such as disinhibition, denial, indifference, overt sadness and aggressiveness, are not rare during the acute phase of stroke and might be overlooked if not searched for systematically with appropriately designed scales. Some of these early behaviors, such as denial, may relate to the late development of depression, anxiety and other disorders. Systematic studies on large samples of patients may allow to establish which of these acute emotional behavioral changes are markers for the delayed development of mood disorders.
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PMID:Affective disorders following stroke. 928 28

The authors report a 63-year-old man with a history of brief isolated manic episodes who became persistently hypomanic after a small right thalamic infarct. Detailed behavioral and neuropsychologic assessment were performed 18 months after the stroke and revealed a prosopoaffective agnosia as the foremost cognitive disorder, i.e., an impairment in the identification of emotional facial expressions with preserved discrimination of facial identity. Difficulties in reasoning on humorous material and other signs of mild right hemisphere dysfunction were present, but other perceptual, frontal and abstract-reasoning cognitive functions were unimpaired. Prosopoaffective agnosia has not been reported previously in thalamic lesions or in primary or secondary mania. The authors discuss the hypothetical relationships between a right hemisphere deficit in processing emotions and relapsing of the patient's hypomanic behavior.
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PMID:Persistent recurrence of hypomania and prosopoaffective agnosia in a patient with right thalamic infarct. 956 Aug 27

Mood disorders constitute a significant clinical problem in patients with a wide range of neurodegenerative disorders. This article reviews recent empirical studies examining depression, anxiety, and mania/disinhibition in patients with focal lesions (stroke), primary subcortical degeneration (Parkinson's disease), and primary cortical degeneration (Alzheimer's disease). Although each neuropsychiatric condition has unique clinical correlates, several common themes can be identified and include similarities in prevalence, neuroanatomic substrate, neurochemistry, and treatment response. Depression, for example, is associated with frontal lobe (primarily left hemisphere) dysfunction in stroke, Parkinson's disease, and Alzheimer's disease, whereas mania and dishinhibition are associated with dysfunction of ventral frontal and ventral temporal structures in both stroke and Alzheimer's disease. These similarities across distinctly different neuropathological conditions can provide important validation of fundamental neuroanatomical, as well as possible psychosocial pathways for the development of mood syndromes in neurological disease. The study of neuropsychiatric syndromes represents an important but relatively understudied area of research, that may ultimately help to illuminate the causes and specific treatments of these important clinical disorders.
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PMID:Mood Disorders in Neurodegenerative Diseases. 1032 Apr 30

Mood disorders associated with stroke have been recognized by clinicians for over 100 years. Recent studies, however, have begun to distinguish whether these mood disorders represent primary disorders or are a secondary consequence of the cerebral infarction. Although poststroke mood disorders share similarities with primary mood disorders in their clinical phenomenology, longitudinal course, and response to treatment, clinical-pathologic correlations during the acute poststroke period have provided a strong argument that these disorders are frequently etiologically linked to the cerebral ischemia. Major depression during the acute stroke period was associated with left frontal and left basal ganglia lesions, while mania was associated with right orbital frontal, basotemporal, basal ganglia, or thalamic lesions. Identification of the mechanism of these disorders will ultimately establish their "secondariness" as well as development of more focused treament strategies.
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PMID:Mood Disorders Secondary to Stroke. 1032 Apr 68

Visual perceptual abnormalities may be caused by diverse etiologies which span the fields of psychiatry and neurology. This article reviews the differential diagnosis of visual perceptual abnormalities from both a neurological and a psychiatric perspective. Psychiatric etiologies include mania, depression, substance dependence, and schizophrenia. Common neurological causes include migraine, epilepsy, delirium, dementia, tumor, and stroke. The phenomena of palinopsia, oscillopsia, dysmetropsia, and polyopia among others are also reviewed. A systematic approach to the many causes of illusions and hallucinations may help to achieve an accurate diagnosis, and a more focused evaluation and treatment plan for patients who develop visual perceptual abnormalities. This article provides the practicing neurologist with a practical understanding and approach to patients with these clinical symptoms.
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PMID:Visual perceptual abnormalities: hallucinations and illusions. 1087 81

A 78-year-old housewife with major depression developed a right-sided infarction in the territory of the middle cerebral arteries, followed by acute post-stroke mania. Comparison between pre- and post-stroke SPECT scans demonstrated a unique pattern of left orbitofrontal hyperperfusion with extensive right frontal hypoperfusion. A functional imbalance between right and left orbitofrontal cortices may be important in mania.
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PMID:Left frontotemporal hyperperfusion in a patient with post-stroke mania. 1605 42


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