Dados do Trabalho

Título

Manic Episode Associated With Ischemic Stroke: Case Report

RESUMO

Case Presentation:
A 61-year-old man was admitted to a psychiatric inpatient center with a manic episode. He had a diagnosis of hypertension and a past history of a short-lived mild depressive episode 4 years ago with spontaneous resolution. The patient had been in his usual state of health until 15 days before the admission, when he presented mood alteration, labile affect, disinhibition, grandiose ideas and persecutory delusions, noted by family and coworkers. At that point, the patient was admitted to the inpatient setting. The neurological exam showed preserved strength, sensitivity, coordination and gait. Laboratory screening tests with serologies showed no alterations. The brain magnetic resonance imaging showed signs of subacute ischemic event in the posterior branch of the left internal capsule and mild microangiopathy. A cerebral magnetic resonance angiography showed no hemodynamically significant stenosis. A treatment with lithium 900mg and olanzapine 5mg was started with great improvement. When the patient was discharged after 3 weeks, he returned to work and kept follow-up on an outpatient basis.

Discussion:
Mania is characterized by affective disturbances and can manifest with various symptoms, including increased talkativeness, flight of ideas, racing thoughts, abnormal distractibility and increased energy. It is reported to be an uncommon manifestation after stroke. In this setting, its frequency is < 1%, compared with depression and other mood disorders. Post-stroke mania should be considered in any manic patient who has concomitant neurological deficits and is older than expected for the onset of primary mania. This presentation is most common when lesions occur in the right cerebral hemisphere, specially in the thalamus and caudate nucleus, although left-sided lesions have also been reported. From a review of the literature, it was noted that most of the data about this topic focuses on case reports.

Final Comments:
The case presented is a rare episode of mania after ischemic stroke with unusual involvement of the left internal capsule which emphasizes the importance of neuroimaging in the first episode of mania. A longer follow-up is needed to assess the recurrence of symptoms and, in this case, distinguish between causality and correlation. Further studies are required to better understand this association of events.

Palavras Chave

Mania; Stroke; Ischemic Stroke; Internal capsule; MRI