Neuropsychiatric disorders following stroke are common, and pathologic involvement of specific regions or functional systems results in behavioral syndromes similar to idiopathic psychiatric syndromes. Depression occurs in up to half of all stroke patients and is most frequently associated with left anterior cortical and subcortical infarctions. Mood changes interfere with cognitive, functional and social recovery. Treatment with heterocyclic antidepressants, stimulants, and electroconvulsive therapy is efficacious in most patients. Mania, delusions, hallucinations, personality alterations, obsessive-compulsive disorder, and changes in sexual behavior are less common but have also been described in post-stroke patients. Each behavioral syndrome is associated with a specific pattern of brain involvement. Investigation of these phenomena contributes to understanding the cerebral basis of psychiatric disorders.
HachinskiV.NorrisJ. W., The Acute Stroke, F. A. Davis, Philadelphia, 1985.
2.
WolfP. A.KannelW. B.VerterJ., Cerebrovascular Disease in the Elderly: Epidemiology, in Clinical Neurology of Aging, AlbertM. L. (ed.), Oxford, New York, pp. 458–477, 1984.
3.
CaplanL. R.SteinR. W., Stroke: A Clinical Approach, Butterworths, Boston, 1986.
4.
RobinsonR. G.StarrL. B.KubosK. L., A Two Year Longitudinal Study of Post-Stroke Mood Disorder: Findings during the Initial Evaluation, Stroke, 14, pp. 736–741, 1983.
5.
RobinsonR. G.PriceT. R., Post-Stroke Depressive Disorders: A Follow-up Study of 103 Patients, Stroke, 13, pp. 635–641, 1982.
6.
SinyorD.JacquesP.KaloupekD. A., Post-Stroke Depression and Lesion Location: An Attempted Replication, Brain, 109, pp. 537–546, 1986.
7.
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, (3rd Edition), American Psychiatric Association, Washington, D.C., 1980.
8.
StarksteinS. E.RobinsonR. G., Affective Disorders and Cerebral Vascular Disease, British Journal of Psychiatry, 154, pp. 170–182, 1989.
9.
HamiltonM. A., A Rating Scale for Depression, Journal of Neurology, Neurosurgery, and Psychiatry, 23, pp. 56–62, 1960.
10.
WingJ. K.CooperJ. E.SantoriusN., Measurement and Classification of Psychiatric Symptoms, Cambridge University Press, London, 1974.
11.
LipseyJ. R.SpencerW. C.RabinsP. V.RobinsonR. G., Phenomenological Comparison of Post-Stroke Depression and Functional Depression, American Journal of Psychiatry, 143, pp. 527–529, 1986.
12.
RobinsonR. G.BolducP. L.PriceT. R., Two Year Longitudinal Study of Post-Stroke Mood Disorders Diagnosis and Outcome at One and Two Years, Stroke, 18, pp. 837–843, 1987.
13.
RobinsonR. G.KubosK. L.StarrL. B., Mood Disorders in Stroke Patients: Importance of Location of Lesion, Brain, 107, pp. 81–93, 1984a.
14.
EastwoodM. R.RifatS.NobbsH., Mood Disorder Following Cerebrovascular Accident, British Journal of Psychiatry, 154, pp. 195–200, 1989.
15.
FolsteinM. F.MailbergerR.McHughP. R., Mood Disorders as a Specific Complication of Stroke, Journal of Neurology, Neurosurgery and Psychiatry, 40, pp. 1018–1020, 1977.
16.
FinklesteinS.BenowitzL. I.BaldessariniR., Mood, Vegetative Disturbance, and Dexamethasone Suppression Test after Stroke, Annals of Neurology, 12, pp. 463–468, 1982.
17.
RobinsonR. G.LipseyJ. R.Bolla-WilsonK., Mood Disorders in Left-Handed Stroke Patients, American Journal of Psychiatry, 142, pp. 1424–1429, 1985.
18.
LipseyJ. R.RobinsonR. G.PearlsonG. D., Mood Change Following Bilateral Hemisphere Brain Injury, British Journal of Psychiatry, 143, pp. 266–273, 1983.
19.
StarksteinS. E.RobinsonR. G.PriceT. R., Comparison of Cortical and Subcortical Lesions in the Production of Post-Stroke Mood Disorders, Brain, 110, pp. 1045–1059, 1987.
20.
StarksteinS. E.RobinsonR. G.PriceT. R., Depressive Disorders Following Posterior Circulation as Compared with Middle Cerebral Artery Infarcts, Brain, 111, pp. 375–387, 1988.
21.
StarksteinS. E.RobinsonR. G.PriceT. R., Comparison of Patients with and without Post-Stroke Major Depression Matched for Size and Location of Lesion, Archives of General Psychiatry, 45, pp. 247–252, 1988.
22.
StarksteinS. E.RobinsonR. G.HonigM. A., Mood Changes after Right-Hemisphere Lesions, British Journal of Psychiatry, 155, pp. 79–85, 1989.
23.
FolsteinM. F.FolsteinS. F.McHughP. R., Mini-Mental State: A Practical Method for Grading the Cognitive State of Patients, for the Clinician, Journal of Psychiatric Research, 12, pp. 189–198, 1975.
24.
Bolla-WilsonK.RobinsonR. G.StarksteinS. E., Lateralization of Dementia of Depression in Stroke Patients, American Journal of Psychiatry, 146, pp. 627–634, 1989.
25.
LipseyR.RobinsonR. G.PearlsonG. D., The Dexamethasone Suppression Test and Mood Following Stroke, American Journal of Psychiatry, 142, pp. 318–323, 1985.
26.
LipseyR.RobinsonR. G.PearlsonG. D., Nortriptyline Treatment of Post-Stroke Depression A Double-Blind Study, The Lancet, 84, pp. 297–300, 1984.
27.
RedingM. J.OrtoL. A.WinterS. W., Antidepressant Therapy after Stroke: A Double-Blind Trial, Archives of Neurology, 43, pp. 763–765, 1986.
28.
LingamV. R.LazarusL. W.GrovesL., Methylphenidate in Treating Post-Stroke Depression, Journal of Clinical Psychiatry, 49, pp. 151–153, 1988.
29.
FeibelH.SpringerC. J., Depression and Failure to Resume Social Activities after Stroke, Archives of Physical Medicine and Rehabilitation, 63, p. 276, 1982.
30.
MurrayG. B.SheaV. S.ConnD. K., Electroconvulsive Therapy for Post-Stroke Depression, Journal of Clinical Psychiatry, 47, pp. 258–260, 1986.
31.
PickelV. M.SegalM.BloomF. E., A Radio-auto-graphic Study of the Efferent Pathways of the Nucleus Locus Ceruleus, Journal of Comparative Neurology, 155, pp. 15–42, 1974.
32.
MorrisonJ. H.MolliverM. E.GrzannaR., Noradrenergic Innervation of the Cerebral Cortex: Widespread Effects of Local Cortical Lesions, Science, 205, pp. 313–316, 1979.
33.
RobinsonR. G., Differential Behavioral and Biochemical Effects of Right and Left Hemispheric Cerebral Infarction in the Rat, Science, 205, pp. 707–710, 1979.
34.
MaybergH. S.RobinsonR. G.WongD. F., PET Imaging of Cortical S2-Serotonin Receptors Following Stroke: Lateralized Changes and Relationship to Depression, American Journal of Psychiatry, 145, pp. 937–943, 1988.
35.
DunneJ. W.LeedmanP. J.EdisR. H., Inobvious Stroke: A Cause of Delirium and Dementia, Australian and New Zealand Journal of Medicine, 16, pp. 771–778, 1986.
36.
RobinsonR. G.BostonJ. D.StarksteinS. E., Comparison of Mania and Depression after Brain Injury: Causal Factors, American Journal of Psychiatry, 145, pp. 172–178, 1988.
37.
StarksteinS. E.RobinsonR. G.BerthierM. L., Differential Mood Changes Following Basal Ganglia vs. Thalamic Lesions, Archives of Neurology, 45, pp. 725–730, 1988.
38.
BogousslavskyJ.FerrazziniM.RegliF., Manic Delirium and Frontal-Like Syndrome with Paramedian Infarction in the Right Thalamus, Journal of Neurology, Neurosurgery, and Psychiatry, 51, pp. 117–119, 1988.
39.
CohenM. R.NiskaR. W., Localized Right Cerebral Hemisphere Dysfunction and Recurrent Mania, American Journal of Psychiatry, 137, pp. 847–848, 1980.
40.
CummingsJ. L.MendezM. F., Secondary Mania with Focal Cerebrovascular Lesions, American Journal of Psychiatry, 141, pp. 1084–1087, 1984.
41.
Van Der LugtP. J. M.DeVisserA. P., Two Patients with a Vital Expansive Syndrome Following a Cerebrovascular Accident, Psychiatrica, Neurologica, and Neurochirugia, 70, pp. 349–359, 1967.
42.
StarksteinS. E.RobinsonR. G., Affective Disorders and Cerebral Vascular Disease, British Journal of Psychiatry, 154, pp. 170–182, 1989.
43.
PeroutkaS. J.SohmerB.KumarA. J., Hallucinations and Delusions Following a Right Temporoparietooccipital Infarction, The Johns Hopkins Medical Journal, 151, pp. 181–185, 1982.
44.
BerthierM.StarksteinS. E., Acute Atypical Psychosis Following a Right Hemisphere Stroke, Acta Neurologica Belgica, 87, pp. 125–131, 1987.
45.
LevineD. N.FinklesteinS., Delayed Psychosis after Right Temporoparietal Stroke or Trauma: Relation to Epilepsy, Neurology, 32, pp. 267–273, 1982.
46.
CuttingJ., The Phenomenology of Acute Organic Psychosis, British Journal of Psychiatry, 151, pp. 324–332, 1987.
47.
FlynnF. G.CummingsJ. L.ScheibelJ., Monosymptomatic Delusions of Parasitosis Associated with Ischemic Cerebrovascular Disease, Journal of Geriatric Psychiatry and Neurology, 2, pp. 134–139, 1989.
48.
FeinbergT. E.ShapiroR. M., Misidentification-Reduplication and the Right Hemisphere, Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 2, pp. 39–48, 1989.
49.
de PauwK. W.SzuleckaT. K.PoltockT. L., Frégoli Syndrome after Cerebral Infarction, The Journal of Nervous and Mental Disease, 175, pp. 433–437, 1987.
50.
SignerS.CummingsJ. L.BensonD. F., Delusions and Mood Changes in Patients with Chronic Aphasia, Journal of Neuropsychiatry and Clinical Neuroscience, 1, pp. 40–45, 1989.
51.
MillerB. L.BensonD. F.CummingsJ. L., Late-life Paraphrenia: An Organic Delusional Syndrome, Journal of Clinical Psychiatry, 47, pp. 204–207, 1986.
52.
MillerB. L.LesserI. M.BooneK., Brain White-Matter Lesions and Psychosis, British Journal of Psychiatry, 155, pp. 73–78, 1989.
53.
PakalnisA.DrakeM. E.Jr., Right Parietooccipital Lacunar Infarctions with Agitation, Hallucinations, and Delusions, Psychosomatics, 28, pp. 95–96, 1987.
54.
CummingsJ. L.MillerB. L.HillM. A., Neuropsychiatric Aspects of Vascular Dementia and Dementia of the Alzheimer Type, Archives of Neurology, 44, pp. 389–393, 1987.
55.
CummingsJ. L., Organic Delusions, British Journal of Psychiatry, 146, pp. 184–197, 1985.
56.
GoodwinJ. A.GorelickP. B.HelgasonC. M., Symptoms of Amaurosis Fugax in Atherosclerotic Carotid Artery Disease, Neurology, 37, pp. 829–832, 1987.
57.
JacobsL.ArpikA.BozianD., Auditory-Visual Synesthesia, Archives of Neurology, 38, pp. 211–216, 1981.
58.
FeinbergW. M.RapcsakS. Z., “Peduncular Hallucinosis” Following Paramedian Thalamic Infarction, Neurology, 39, pp. 1525–1536, 1989.
59.
GellerT. J.BellurS. N., Peduncular Hallucinosis Magnetic Resonance Imaging Confirmation of Mesencephalic Infarction during Life, Annals of Neurology, 21, pp. 602–604, 1987.
60.
RozanskiJ., Peduncular Hallucinosis Following Vertebral Angiography, Neurology, 2, pp. 341–349, 1952.
61.
CaplanL. R., “Top of the Basilar” Syndrome, Neurology, 30, pp. 72–79, 1980.
62.
NakajimaK., Clinicopathologic Study of Pontine Hemorrhage, Stroke, 14, pp. 485–493, 1983.
63.
KolmelH. W., Coloured Patterns in Hemianopic Fields, Brain, 107, pp. 155–167, 1984.
64.
KolmelH. W., Complex Visual Hallucinations in the Hemianopic Field, Journal of Neurology, Neurosurgery, and Psychiatry, 48, pp. 29–38, 1985.
65.
CummingsJ. L.MillerB. L., Visual Hallucinations, Western Journal of Medicine, 146, pp. 46–51, 1987.
66.
CascinoG. D.AdamsR. D., Brainstem Auditory Hallucinosis, Neurology, 36, pp. 1042–1047, 1986.
VerfaellieM.HeilmanK. M., Response Preparation and Response Inhibition after Lesions of the Medial Frontal Lobe, Archives of Neurology, 44, pp. 1265–1271, 1987.
69.
StrubR. L., Frontal Lobe Syndrome in a Patient with Bilateral Globus Pallidus Lesions, Archives of Neurology, 46, pp. 1024–1027, 1989.
70.
MendezM. F.AdamsN. L.LewandowskiK. S., Neurobehavioral Changes Associated with Caudate Lesions, Neurology, 39, pp. 349–354, 1989.
71.
GentiliniM.De RenziE.CrisisG., Bilateral Paramedian Thalamic Artery Infarcts: Report of Eight Cases, Journal of Neurology, Neurosurgery, Psychiatry, 50, pp. 900–909, 1987.
72.
GubermanA.StussD., The Syndrome of Bilateral Paramedian Thalamic Infarction, Neurology, 33, pp. 540–546, 1983.
73.
KatzD. I.AlexanderM. P.MandellA. M., Dementia Following Strokes in the Mesencephalon and Diencephalon, Archives of Neurology, 44, pp. 1127–1133, 1987.
74.
DianL.CummingsJ. L.PetryS., Personality Alterations in Vascular Dementia, Psychosomatics, (in press).
75.
AlexanderG. E.DeLongM. R.StrickP., Parallel Organization of Functionally Segregated Circuits Linking Basal Ganglia and Cortex, Annual Review of Neuroscience, 9, pp. 357–381, 1986.
76.
BarrisR. W.SchumanH. R., Bilateral Anterior Cingulate Gyrus Lesions, Neurology, 3, pp. 44–52, 1953.
77.
NielsenJ. M.JacobsL. L., Bilateral Lesions of the Anterior Cingulate Gyrus, Bulletin of the Los Angeles Neurological Society, 16, pp. 231–234, 1951.
78.
SegarraJ. M., Cerebral Vascular Disease and Behavior, Archives of Neurology, 22, pp. 408–418, 1970.
79.
LogueV.DurwardJ.PrattR. T. C., The Quality of Survival after Rupture of an Anterior Cerebral Aneurysm, British Journal of Psychiatry, 114, pp. 137–160, 1968.
80.
MillerB. L.CummingsJ. L.McIntyreH., Hypersexuality or Altered Sexual Preference Following Brain Injury, Journal of Neurology, Neurosurgery, and Psychiatry, 49, pp. 867–873, 1986.
81.
CoslettH. B.HeilmanK. M., Male Sexual Function, Archives of Neurology, 43, pp. 1036–1039, 1986.
82.
CroisileB.TourniareD.ConfavreuxC., Bilateral Damage to the Head of the Caudate Nuclei, Annals of Neurology, 25, pp. 313–314, 1989.
83.
LillyR.CummingsJ. L.BensonD. F., The Human Kluver-Bucy Syndrome, Neurology, 33, pp. 1141–1145, 1983.
84.
ShrabergD.WeisbergL., The Kluver-Bucy Syndrome in Man, The Journal of Nervous and Mental Disease, 166, pp. 130–134, 1978.
85.
MedinaJ. L.RubinoF. A.RossE., Agitated Delirium Caused by Infarctions of the Hippocampal Formation and Fusiform and Lingual Gyri: A Case Report, Neurology, 24, pp. 1181–1183, 1974.
86.
CummingsJ., Clinical Neuropsychiatry, Grune and Stratton, New York, 1985.
