POST-STROKE ACUTE ELATION SHORTLY FOLLOWED BY PATHOLOGIC JEALOUSY - IS THERE A COMMON ANATOMIC SUBSTRATE?

Both mania and psychotic symptoms are well known to result from vascular brain injury, but their pathophysiology remains largely unknown. A 69-year-old man with diabetes and hypertension was seen for sudden behaviour disturbance: euphoric, talkative and uninhibited, he continuously shouted he trusted in Medicine, called the doctor the “King of Medicine”, and repeatedly said “I love doctors, I love nurses, I love Hospitals”. He was overcompliant during neurologic exploration, clearly amused with it. Left sensitive hemi-inattention and left homonymous hemianópsia could also be found. MRI showed an acute right temporo-parieto-insular cortical infarction. The following day he was euthymic and embarrassed for what happened. When visited that afternoon by his wife, she noticed he was strangely suspicious, continuously surveilling all her moves. He progressively worsened, believing she was having affairs with several men. This delusion persisted for the following months, even on risperidone 1 mg/day, culminating in Christmas Eve, when the patient shocked his family saying that his wife was having an affair with one of their sons. At this time, risperidone was discontinued and replaced by quetiapine 200 mg/day, resulting in rapid fading of all symptoms. Both post-stroke mania and psychotic symptoms have been consistently associated with right hemisphere damage, but, to our knowledge, were not previously reported after the same injury. We believe our patient provides evidence that the same anatomic dysfunction, in this case a temporoparietal infarct, can cause both psychiatric phenomena.