The neuropsychiatric complications associated with cerebrovascular disease include a wide range of emotional and cognitive disturbances.
MAJOR DEPRESSION
Ø Prevalence: 20% of patients with cerebrovascular disease
Ø Clinical symptoms: Disheartened mood, gloominess, dreariness, pessimism, diurnal mood variation, anergia, weight loss, early-morning awakening
Ø Associated lesion location: Left frontal lobe and left basal ganglia during the acute period after stroke
Ø Treatment: Pamelor: proved effective in randomized placebo-controlled dbl studies
MINOR DEPRESSION
Ø Prevalence: 10-40% of patients with cerebrovascular disease
Ø Clinical symptoms: Lugubrious mood, disinclined to social interaction, decreased appetite, uneasiness, disquiet
Ø Associated lesion location: Left posterior parietal and occipital regions during the acute poststroke period
Ø Treatment: No controlled studies. SSRIs perhaps???
APATHY
Ø Prevalence: 22% of patients with cerebrovascular disease
Ø Clinical symptoms: Anhedonia, doleful demeanor, ennui, languor
Ø Associated lesion location: Posterior internal capsule
Ø Treatment: No controlled studies. Cognitive Behavior Therapy, perhaps???
MANIA
Ø Prevalence: Rare
Ø Clinical symptoms: Grandiloquent mood, libertine appetites, magniloquent well-being
Ø Associated lesion location: Right basotemporal or right orbitofrontal lesions
Ø Treatment: Depakote
ANXIETY DISORDER
Ø Prevalence: 27% of patients with cerebrovascular disease
Ø Clinical symptoms: Apprehensive dread, restiveness, insomnia, fretfulness, angst
Ø Associated lesion location: Left cortical lesions, usually dorsolateral frontal lobe
Ø Treatment: Avoid benzodiazepines because they impair cognition
CATASTROPHIC REACTION
Ø Prevalence: 19% of patients with cerebrovascular disease
Ø Clinical symptoms: Choleric agitation, strident acrimony, bellicosity, vitriolic brooding, menacing intimidation, obstreperous attitude, scurrilous vocabulary
Ø Associated lesion location: Left anterior-subcortical region
Ø Treatment: No studies. Depakote, perhaps???
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