Secondary Mania after Cerebral Infarction in the Recovery Phase: Case Report

Introduction: Although patients commonly experience psychological disorders such as depression following cerebrovascular events, mania is extremely rare. Here we present a patient who experienced secondary mania while being hospitalized in a convalescent rehabilitation ward following cerebral infarction.

Case: The patient was a 70-year-old man who was hospitalized at our hospital for convalescent rehabilitation after suffering mild right hemiplegia and higher brain dysfunction following cerebral infarction. During hospitalization, the patient experienced a progression-free course. Upon awakening on day 26 after hospitalization, the patient suddenly showed signs of mania. The symptoms included elevated mood, pressured speech, hyperactivity, insomnia, and agitation; these symptoms caused problems in his daily life at the hospital. On day 29 after hospitalization, the patient was referred to a psychiatric hospital as an outpatient. He was diagnosed with organic manic disorder and was hospitalized. The patient was administered lithium carbonate (Limas^®; 400 mg daily) and risperidone (Risperdal^®; 2 mg daily). Because the mania persisted for more than 1 week, he was diagnosed with secondary mania. His manic state gradually improved, and he was transferred to our hospital. He was able to undergo rehabilitation without any problem and with no exacerbation of mania. The patient was discharged on day 139 after readmission.

Discussion: In cases where patients with cerebrovascular disorders display abnormal behavior, it becomes necessary to differentiate between secondary mania and social behavior disorder. Because mania has a negative impact on the patient's hospitalization and convalescence, if secondary mania is suspected, early consideration of psychiatric treatment is required.

Keywords: cerebral infarction; convalescent rehabilitation; late-onset mania; secondary mania; social behavior disorder.