Resolution of bipolar II and panic disorders following subarachnoid hemorrhage

Cerebral infarction producing psychiatric disorders such as depression and mania is a recognized phenomenon. However, resolution of affective disorders following stroke has not been previously reported. We describe the case of a 53-year-old woman with a 25-year history of treatment-resistant bipolar II and panic disorders. At the age of 46, she experienced a subarachnoid hemorrhage with secondary vasospasm that resulted in a stroke. Shortly following the hemorrhage, the patient experienced a complete remission of both psychiatric illnesses that has been sustained for 7 years. Initial computed tomography (CT) and angiography studies revealed subarachnoid hemorrhage with intraventricular extension, communicating hydrocephalus, and aneurysms of the left posterior communicating artery and the right anterior cerebral artery. Following clipping of the left internal posterior communicating artery aneurysm, the patient developed vasospasm with further stroke symptoms. A subsequent CT scan showed a fully developed ischemic infarct in the left temporoparietal region that was confirmed by follow-up magnetic resonance imaging (MRI). We present a 7-year follow-up with complete psychiatric interview, chart review, and MRI. The present case demonstrates the importance of continued efforts to localize neural circuits involved in the pathogenesis and maintenance of affective disorders.