Mania, pseudomania, depression, and pseudodepression resulting from focal unilateral cortical lesions

This consecutive multiple case study was designed to determine whether cortical lesion sites can predict occurrence of mood or psychomotor disorders in adults and children.

Most of a large body of research supports the contention that left hemisphere lesions result more often than right ones in depression, and that the inverse occurs in mania. However, it is not clear how psychomotor status fits into this picture, nor whether children respond to the same lesions in a similar manner.

Published (n = 88) and unpublished (n = 31) cases of school-aged child and adult patients with focal unilateral cortical lesions and psychomotor agitation or lethargy with or without corresponding mania or depression were reviewed systematically to determine whether lesion location relates systematically to any of those psychiatric conditions. No patients had symptoms prior to detection of their lesion. Manic-depressives and agitated depressives were also excluded.

Patients with mania and/or psychomotor agitation had predominantly right hemisphere lesions. Postlesion hyperactivity (without mania) in children was common but was not more related to lesions in one or the other hemisphere. Adult and child patients with depression and/or psychomotor lethargy had predominantly left hemisphere lesions. The intrahemispherical site of the lesion did not significantly predict the type of mood or psychomotor disorder. Nevertheless, the nonsignificant trend was for right posterorolandic lesions to predict mania or agitation and for left frontal lesions to predict depression or psychomotor lethargy.

These findings support the neuropsychiatric approach to mood and psychomotor disorder in children and adults.