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

Objective: This consecutive multiple case study was designed to determine w hether cortical lesion sites can predict occurrence of mood or psychomotor disorders in adults and children. Background: Most of a large body of resea rch supports the contention that left hemisphere lesions result more often than right ones in depression, and that the inverse occurs in mania. Howeve r, it is not clear how psychomotor status fits into this picture, nor wheth er children respond to the same lesions in a similar manner. Method: Publis hed (n = 88) and unpublished (n = 31) cases of school-aged child and adult patients with focal unilateral cortical lesions and psychomotor agitation o r lethargy with or without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 d etection of their lesion. Manic-depressives and agitated depressives were a lso excluded. Results: 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 psyc homotor lethargy had predominantly left hemisphere lesions. The intrahemisp herical site of the lesion did not significantly predict the type of mood o r psychomotor disorder. Nevertheless, the nonsignificant trend was for righ t posterorolandic lesions to predict mania or agitation and for left fronta l lesions to predict depression or psychomotor lethargy. Conclusions: These findings support the neuropsychiatric approach to mood and psychomotor dis order in children and adults.