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Psychotic behavior after right hemispheric cerebrovascular accident: a case report
1Department of Physical Medicine and Rehabilitation, University of Michigan Medical Center, Ann Arbor.
Archives of Physical Medicine and Rehabilitation
|April 1, 1992
Summary
Psychotic behaviors like hallucinations can occur after a right-hemisphere stroke. These symptoms may be episodic or continuous, responding differently to treatments like anticonvulsants or antipsychotic agents.
Area of Science:
- Neurology
- Neuropsychiatry
Background:
- Cerebrovascular accidents (CVAs) can lead to a range of neurological deficits.
- Psychotic behaviors following a CVA are uncommon but documented.
- Right-hemisphere lesions are more frequently associated with post-stroke psychosis.
Observation:
- A 64-year-old male presented with hallucinations, delusions, and agitation post-right hemispheric CVA.
- The CVA affected the occipital, inferior temporal, and parietal regions supplied by the posterior cerebral artery.
- Literature review indicates psychotic behavior post-CVA is rare, typically linked to right-hemisphere lesions.
Findings:
- Two distinct clinical presentations of post-CVA psychosis are identified.
- Presentation 1: Patients without chronic disease develop episodic psychosis remotely from the CVA, often with epileptogenic foci on EEG, improving with anticonvulsants.
- Presentation 2: Patients with chronic diseases and brain atrophy exhibit continuous abnormal behavior soon after CVA, with variable response to antipsychotics.
Implications:
- Understanding these presentations aids in diagnosing and managing post-stroke psychosis.
- Right-hemisphere strokes require careful neuropsychiatric evaluation.
- Tailoring treatment based on clinical presentation and underlying pathology is crucial for patient outcomes.