THALAMO-FRONTAL PSYCHOSIS

A 43-year-old man presented with an 18-month history of acute-onset cy clical behavioural change affecting mood, appetite, sleep, and energy levels. This had followed an initial episode of transient drowsiness w hich lasted 24 hours. On examination, there was some evidence of visua l memory and frontal lobe deficits. A brain CT scan showed bilateral t halamic infarcts and a brain SPECT scan showed bilateral hypoperfusion of the frontal lobes. To our knowledge, this is the first reported ca se of thalamic infarction associated with acute-onset cyclical affecti ve psychosis with clinical and neurophysiological features of frontal lobe syndrome. The case also highlights the possible role of thalamo-f rontal circuits in the pathogenesis of the Kleine-Levin syndrome.