Abstract
A 64-year-old man developed hallucinations, delusions, and agitation after a right hemispheric cerebrovascular accident (CVA) in the occipital, inferior temporal, and parietal regions of the posterior cerebral artery. A review of the literature suggests that psychotic behavior is rare after CVA, but when such behavior does occur, the lesion is usually in the right hemisphere. Two clinical presentations are seen. One presentation involves patients free of chronic disease who develop episodic psychotic behavior at a time remote from their CVA. Electroencephalogram often demonstrates epileptogenic foci, and these patients often improve with anticonvulsant medication. Another presentation involves patients with one or more chronic diseases, often resulting in brain atrophy, who display continuous abnormal behavior soon after their CVA; these patients respond variably to antipsychotic agents.
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