Abstract
BackgroundPost-stroke mania is an infrequent complication after stroke, and the mechanisms underlying this disorder remain unclear. Although a contralesional release phenomenon has been implicated in post-stroke mania, empirical findings are lacking.Case presentationWe present a case report of post stroke mania. Single photon emission tomography (SPECT) was performed twice, during the manic state and during the remitted euthymic state. The first SPECT study performed during the manic state demonstrated hypoperfusion in the right temporal and frontal regions due to right putaminal hemorrhage. It also showed hyperperfusion in the inferior lateral prefrontal lobe, the temporal lobe, and the medial and lateral parts of the parietal lobe in the left hemisphere. The second SPECT study performed during the euthymic state demonstrated moderate improvement in the hypoperfusion in the right fronto-temporal regions. Furthermore, compared to the findings on the first SPECT study, the second study showed that the focal hyperperfusion in the anterior insular cortex, inferior lateral prefrontal lobes, and superior-middle temporal gyrus in the left hemisphere had vanished.ConclusionIncreased left inferior prefrontal and anterior insular activity and reduced extensive right fronto-temporal lobe activity are involved in the development of post-stroke mania.
Highlights
Post-stroke mania is an infrequent complication after stroke, and the mechanisms underlying this disorder remain unclear
Increased left inferior prefrontal and anterior insular activity and reduced extensive right fronto-temporal lobe activity are involved in the development of post-stroke mania
We hypothesized that the regional cerebral blood flow in the manic state demonstrates right fronto-temporal lobe hypoperfusion due to the brain hemorrhage itself and hyperperfusion in the left orbito-fronto-temporo-parietal regions resulting from contralesional release phenomenon, and that this increased activity of the left hemisphere would resolve into the normal state after recovery from poststroke mania
Summary
Post-stroke mania is an infrequent complication after stroke, and the mechanisms underlying this disorder remain unclear. Conclusion: Increased left inferior prefrontal and anterior insular activity and reduced extensive right fronto-temporal lobe activity are involved in the development of post-stroke mania. Findings from previous neuroimaging studies demonstrated that post-stroke mania is more often associated with lesions in the right hemisphere than in the left hemisphere [2,3,4].
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