David L. Perez, Eva Catenaccio and Jane Epstein
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. In This article, 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.