Late onset bipolar disorder due to a lacunar state

Abstract

Objective: To describe a patient with a new onset bipolar disorder (BD) type II, secondary to a lacunar state.

Background: Poststroke BD is rare and mainly associated with lesion in the prefrontal-striatal-thalamic circuit.

Materials and methods: A 51-year-old woman came to our attention for a mood disorder of recent onset. At 49, she had suffered acute left-sided limb weakness that improved spontaneously four days later. Arterial hypertension was subsequently diagnosed. After 6 months, she began to suffer from alternating brief periods of expansive and elevated mood with longer periods of depressed mood, with a suicide attempt. We performed extensive laboratory and instrumental investigations, as well as, psychiatric consultation, and a cognitive assessment, which was repeated 9 months later.

Results: Brain magnetic resonance disclosed leukoaraiosis and a lacunar state of the basal ganglia. Transcranial Doppler showed a patent foramen ovale. A psychiatric consultation led to the diagnosis of BP type II. Neuropsychological evaluation detected deficits in attention/executive functions, verbal fluency, and memory. Nine months later, after specific psychiatric therapy, the psychiatric symptoms were remarkably improved.

Conclusion: Our case sheds light on the role of the basal ganglia in mood disorders and the importance of ruling out brain injury in late onset BP.

Figure 1

Cerebral MRI: lacunar state, with prominent lesions on the left caudate ((a and c) arrow), bilateral putamen ((b and c) arrow), and left pons (d).