POSTSTROKE BIPOLAR AFFECTIVE-DISORDER - CLINICAL SUBTYPES, CONCURRENTMOVEMENT-DISORDERS, AND ANATOMICAL CORRELATES

The authors describe 9 patients with bipolar affective disorder associ ated with cerebrovascular lesions. Eight had negative family histories of affective disorders and late age at onset (after age 40) of manic- depressive symptoms. Only one, with positive family history of affecti ve disorders, developed moon swings before age 40. Clinical subtypes o f bipolar disorder and patterns of affective cycling in these stroke p atients resembled those previously reported in functional bipolar diso rder. Five patients had concurrent hyperkinetic movement disorders, an d one depressed patient presented with unilateral left-sided parkinson ism that disappeared during a manic switch. In most patients, bipolar affective disorder was associated with right hemisphere lesions that i nvolved subcortical and midline structures. Findings suggest that dama ge to frontal-basal ganglia-thalamocortical circuits by subcortical va scular lesions may simultaneously provoke disorders of movement and mo od regulation.