Behavioral Disconnection Syndrome Manifesting as Combined Mania and Visual-Auditory Hallucinations Secondary to Isolated Right Thalamic Hemorrhage
Case Report
Discussion
Mania
Study | Sex | Age (Years) | Locations | Hemisphere | Onset | Etiologies | Manic Symptoms | Associated Symptoms | Treatment |
---|---|---|---|---|---|---|---|---|---|
Cummings et al.13 | Two cases | NA | Unspecified | Right | Acute | Ischemic stroke | Case 1: euphoria, talkativeness, hypersexuality, euphoric, irritable, and poor judgement | Hemisensory loss, amnesia, denial of illness, and depression (case 2) | Lithium in one case with improvement; no medication in one case |
Case 2: euphoric, decreased need for sleep, and preoccupied with religion | |||||||||
Gentilini et al.14 | Male | 66 | Paramedian | Right and Left | Acute | Ischemic Stroke | Hypersexuality, grandiosity, and cheerfulness | Amnesia, somnolence, and delusion | Not reported |
Female | 47 | Paramedian | Right and Left | Acute | Ischemic stroke | Hyperphagia, euphoria, and childish behaviors | Hypersomnolence, abnormal eye movement, and depression | Not reported | |
Male | 35 | Paramedian | Right and Left | Acute | Ischemic stroke | Hyperphagia and irritability | Amnesia | Not reported | |
Bogousslavsky et al.6 | Female | 72 | Paramedian, dorsomedial and ventral lateral | Right | Acute | Ischemic stroke | Smiling and inappropriate laughing and jokes, logorrhea, rapid switching of ideas, lack of spontaneity, and disinhibition | Hypersomnolence, disorientation, | Not reported |
Starkstein et al.15 | Three cases | NA | Unspecified | Right | NA | Hemorrhage and ischemic stroke | Mania (unspecified symptoms in each case) | NA | NA |
Kulisevsky et al.16 | Female | 81 | Ventral lateral and ventromedial | Right | Acute | Ischemic stroke | Euphoria, talkativeness, grandiosity, flight of ideas, inappropriate jokes, and decreased need for sleep | Left hemichorea | Haloperidol with improvement after 4 weeks |
McGilchrist et al.17 | Male | 43 | Paramedian | Right and Left | Acute | Ischemic stroke | Cyclic elation, hypersexuality, hyperphagia, flight of ideas, and decreased need for sleep | Hypersomnolence, cyclical apathy and depression | Not reported |
Daum et al.18 | NA | 64 | Anterior | Right | Acute | Ischemic Stroke | Hypersexuality, talkativeness, irritability, mood fluctuation, and verbal aggression | Amnesia | Not reported |
Vuilleumier et al.19 | Male | 63 | Unspecified | Right | Acute | Ischemic stroke | Mania episode followed by hypomania | Prosopoaffective agnosia | Not reported |
Leibson20 | Male | 53 | Unspecified | Right | Acute | Hemorrhage | Talkativeness, cheerfulness, hypersexuality, and increased energy | Anosognosia, headache and left-sided numbness and weakness, gaze problem, and hemineglect, | Resolved 10 weeks after the stroke |
Inzelberg et al.21 | Male | 61 | Pulvinar | Right | Acute | Ischemic stroke | Euphoria, talkativeness, disinhibition, flight of ideas, hypersexuality, decreased need for sleep, and increased goal-directed activity | Left hemichorea | Haloperidol with improvement after 8 weeks |
Benke et al.7 | Male | 38 | Dorsomedial, intralaminar and anterior | Right and Left | 4 weeks | Ischemic stroke | Logorrhea, restlessness, mood elevation, inflated self-esteem, reduced need for food and sleep, and hypersexuality | Amnesia, vertical gaze paralysis, and dysarthria | Low-dose neuroleptic with improvement after 8 weeks |
Lopez et al8 | Male | 63 | Unspecified | Right | 5 months | Ischemic stroke | Cyclic mania | Bipolar symptoms with cyclic depression, and melancholic stupor | Risperidone, valproic acid, and quetiapine for mania |
Routh and Hill22 | Male | 83 | Posterior | Right | 2 weeks | Hemorrhage | Aggressiveness, speech disinhibition, talkativeness, flight of ideas, and inflated self-esteem | Paranoid delusions | Olanzapine |
Julayanont et al. (current case) | Male | 55 | Dorsomedial and pulvinar | Right | Acute | Hemorrhage | Irritability, grandiosity, combative speech, high-energy levels, decreased need for sleep, pressurized speech, euphoria, and inappropriate cheerfulness | Paranoid delusions and amnesia | Risperidone with improvement after 4 weeks |
Peduncular Hallucinosis
Study | Sex | Age (Years) | Locations | Hemisphere | Etiologies | Onset | Hallucination Features | Associated Symptoms | Treatment | |
---|---|---|---|---|---|---|---|---|---|---|
Visual | Auditory | |||||||||
Feinberg and Rapcsak23 | Male | 83 | Dorsomedial | Right | Ischemic stroke | Acute | Animals in his house (flying birds and dogs), military marching, girls in an examination room | No | Vertigo, ataxic gait | Resolved in 1 week |
Serra et al.24 | Male | 68 | Posterior | Right | Ischemic stroke | Acute | Animals and men’s head | No | Left hemiparesis, paraesthesias | Not reported |
Inzelberg et al.25 | Female | 75 | Unspecified | Left | Ischemic stroke | 2–3 days | No | Musical hallucination of popular songs from her youth | Right hemiparesis and dysphasia | Improved with no reported treatment |
Noda et al.26 | Male | 72 | Dorsomedial | Right | Ischemic stroke | 3 days | Vivid recollection of his old job, dish of sweet potatoes and cigarette between his fingers | No | Hypersomnolence and nocturnal insomnia | Resolved over 2 weeks with no reported treatment |
Female | 46 | Anterior | Left | Ischemic stroke | 4 days | Parents who passed away 10 years ago, teapot and teacups on a table | Commanding voice: “Don’t eat” | Memory impairment, right upper limb weakness | Resolved over 2 weeks with no reported treatment | |
Manford and Anderson27 | Male | 58 | Pulvinar | Right | Ischemic stroke | 10 days | Ball of light, a man in a suit, a black butterfly, dwarves, striped fish swimming | No | No | Not reported |
Yoshida et al.28 | Female | 73 | Dorsomedial | Left | Ischemic stroke | 2 months | No | Voices telling her about misfortunes, voices of threats and commands, | Anterograde and retrograde amnesia | Risperidone and olanzapine |
Mollet et al.29 | Female | 61 | Lateral | Right | Ischemic stroke | Acute | College-age boys in colorful Hawaiian shirts, men in black religious clothes | Conversation between college boys | Pain and numbness at the left hemibody | Not reported |
Güzelcan et al.30 | Male | 46 | Unspecified | right | Tumor | Not reported | Parades of people, seeing spiders, mice running | No | No | Risperidone |
Mittal and Khan31 | Female | 19 | Ventroanterior | Left | Ischemic stroke | Acute | No | Commanding Voices | Confusion, flat affect, imaginary boyfriend, and paranoid delusion | Risperidone |
Lee et al.32 | Male | 20 | Anterior | left | Ischemic stroke | Acute | Dangerous hands and snakes | No | Amnesia, anomia, and depersonalization | Not reported |
Fornazzari et al.12 | Male | 45 | Lateral and posterior | Left | Hemorrhage | 9 months | Sound-tactile, sound-color, and grapheme-gustatory synesthesias | No | Not reported | |
Delgado and Bogousslavsky33 | Male | 61 | Dorsomedial | Left | Ischemic stroke | Acute | Body distortion above the waist, lights and mice running down the wall | No | Transient perioral and left paresthesias | Disappeared without treatment |
Female | 48 | Paramedian | Right and Left (right >left) | Ischemic stroke | Acute | No | Voice and noise distortion made by “dinosaurs” | Disorientation | Disappeared without treatment | |
Julayanont et al. (current case) | Male | 55 | Dorsomedial and pulvinar | Right | Hemorrhage | 12 months | Transient texts on his phone, unknown people and colorful airplanes | Musical hallucination | Paranoid delusions and amnesia | Risperidone |
Network Model of Mania and Hallucinations Secondary to Thalamic Insults
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