ESCOLA PAULISTA MED,DEPT PSIQUIAT,RUA BOTUCATU,740-3 ANDAR,BR-04023900 São Paulo,BRAZILESCOLA PAULISTA MED,DEPT PSIQUIAT,RUA BOTUCATU,740-3 ANDAR,BR-04023900 São Paulo,BRAZILWeb of Scienc

Delporto, J. A.

Mari, J. D.

Turecki, G.

The British Journal of Psychiatry

ESCOLA PAULISTA MED,DEPT PSIQUIAT,RUA BOTUCATU,740-3 ANDAR,BR-04023900 São Paulo,BRAZILAmbulatório de Distúrbios Afetivos, Departamento de Psiquiatria, Escola Paulista de Medicina, Rua Botucatu, 740–3° andar, 04023–900-São Paulo, BrazilWeb of Scienc

Turecki, Gustavo [UNIFESP]

Mari, Jair de Jesus [UNIFESP]

Del Porto, José Alberto [UNIFESP]

Repositório Institucional UNIFESP

British Journal of Psychiatry (1993), 163, 690â€”70lContents: Bipolar disorder following a left basal â€”¿ganglia stroke/Recruitment for post-natal depression studies/Tricyclic â€”¿induced seizures andabsent ECT response/Alzheimer's diseaseand Lewybody dementia/Psychiatric morbidity in the relativesofschizophrenic probands/Lithium toxicity at therapeutic serum levels/Catatonia: the tension insanity!Low serum cholesterol and suicide/Eye-movementdesensitisation to overcome post-traumatic stressdisorder/How well are â€˜¿cured'anorexic nervosapatients?/Psychiatric symptoms in cannabis users/Fluoxetine â€”¿induced mania in a patient with poststroke depression/Relapse following withdrawal ofdrug addiction/Percutaneous endoscopic gastrostomyand severe endogenous depression.Bipolar disorder following a left basal-ganglia strokeSIR: Typical bipolar disorder (BD) may occur inresponse to various physical causes such as brainstroke with clinical manifestations remarkably similar to those found in patients with functional BD(Starkstein & Robinson, Journal, February 1989,154, 170â€”182).Many authors have suggested thatthere is a preponderance of right-sided lesions(Cummings & Mendez, 1984; Danel et al, 1989) andthat the location would be mainly in a limbic orlimbic-related area. We report on a patient in whoma BD developed secondary to a left basal-gangliastroke.Case report. The patient was a 47-year-old right-handedman who had negative family history of affective disorderor other psychiatric illness. He had no psychiatric symptoms until the age of 46, when he suddenly developed amanic syndrome characterised by euphoria, grandiosedelusions, talkativeness, irritability, insomnia and spendingof large amounts of money. He also showed increased libidoand activity.The patient was initially taken to a neurological servicewhere a cranial computerised tomography scan was doneand resulted in a left basal-ganglia stroke. He did notpresent any motor symptoms. The manic episode wastreated with a standard neuroleptic and gradually gave riseto a depressive phase characterised by lassitude, depressivemood, apathy, early morning awakening, loss of libido,anorexia and suicidal thoughts. When the patient came toour out-patient servicehe was at the end of this majordepressive episode, presenting mild symptoms. The patientwas started on lithium therapy associated to clonazepamand he has remained asymptomatic.Secondary BD is a relatively rare consequence ofstroke because it requires two factors: firstly a predisposing factor ofeither a genetic loading for affective disorder or subcortical atrophy; and secondly alesion ofa specific right-hemisphere limbic-connectedstructure (Starkstein & Robinson, 1989, see above).Despitethis, ourpatientdid not havea family historyofaffective disorder, nor did the lesion affect the righthemisphere. The basal ganglia, as a limbic-relatedarea, may be implicated in cases of this pathology.The interval between acquiring the brain lesion andthe onset of mania may be as long as three years(Shukla et al, 1987;Starkstein & Robinson, 1989,seeabove); we do not exactly know when the patient hada stroke as he did not have any motor symptomspreceding the manic episode.Although this casecontributes to the concept thatthe limbic and limbic-related areas are implicatedin the aetiology of BD, it also supports the opinionof Jampala & Abrams (1983) that it is prematureto consider mania to be a syndrome of the nondominant hemisphere.CUMMINGS,J. L. & MENDEZ, M. F. (1984) Secondary mania withfocal cerebrovascular lesions. American Journal of Psychiatry,141, 1084-1087.DANEL, T., COMAYRAS, S., GOUDEMAND, M., el al(1989) Troubles del'humeuret infarctusde l'h@misphÃ¨red oit. Lâ€˜¿EncÃ©phale,XV,549â€”553.JAMPALA,V. C. & ABRAMs,R. (1983) Mania secondary to left andright hemisphere damage. American Journal of Psychiatry, 140,1197â€”1199.SHUKLA, S., COOK, B. L., MulusuuEE, S., el a/(l987) Mania following head trauma. American Journal of Psychiatry. 144,93â€”96.GUSTAVO TURECKIJAIR DE JEsus MAR!JosÃ‰ALBERTO DEL PORTOAmbulatÃ³rio de Disti@rbiosAfetivosDepartamento de PsiquiatriaEscola Paulista de MedicinaRua Botucatu, 740â€”3Â°andar04023â€”900â€”¿SÃ¢oPauloBrazil690Correspondence10.1192/bjp.163.5.690Access the most recent version at DOI: 1993, 163:690.BJP G Turecki, J de J Mari and J A Del PortoBipolar disorder following a left basal-ganglia stroke.Referenceshttp://bjp.rcpsych.org/content/163/5/690.citation#BIBLThis article cites 0 articles, 0 of which you can access for free at: permissionsReprints/permissions@rcpsych.ac.ukto To obtain reprints or permission to reproduce material from this paper, please writeto this article atYou can respond /letters/submit/bjprcpsych;163/5/690from DownloadedThe Royal College of PsychiatristsPublished by  on June 1, 2016http://bjp.rcpsych.org/http://bjp.rcpsych.org/site/subscriptions/ go to: The British Journal of PsychiatryTo subscribe to 

BIPOLAR DISORDER FOLLOWING A LEFT BASAL-GANGLIA STROKE

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Repositório Institucional UNIFESP