Affective and behavioral neuropsychiatric disturbances are frequently encountered in post-stroke patients. While the neural correlates of conditions such as post-stroke depression and apathy have been well investigated, confusion, hyperactive delirium, and secondary mania are less well detailed. A case of right hemispheric stroke presenting with acute confusion and agitation is described to introduce the topic, followed by a focused review of the post-stroke right hemispheric lesional correlates of non-agitated confusion, hyperactive delirium, and secondary mania. These three post-stroke syndromes have both overlapping and non-overlapping structural components. Non-agitated confusional states may preferentially involve higher order perceptual/attentional association cortices (parietal, occipital, prefrontal) and related subcortical connections. Right hemispheric post-stroke patients with hyperactive delirium often share similar lesion sites, but also have a greater tendency to involve limbic related medial temporal lobe structures. Lesions particularly associated with secondary mania include orbitofrontal-subcortical circuits and medial temporal lobe structures. Further investigations using more recently developed advanced structural and functional neuroimaging techniques, including automated volumetric and functional connectivity analyses, are needed to provide added specificity to the delineation of structure-function relationships in these patient populations.
Last date updated on September, 2020