Aggressive Behavior and Posterior Cerebral Artery Stroke

• Published in: Archives of neurology (Chicago) Vol. 64; no. 7; pp. 1029 - 1033
• Main Authors: Botez, Stephan A, Carrera, Emmanuel, Maeder, Philippe, Bogousslavsky, Julien
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.07.2007
• Subjects: Aged; Aged, 80 and over; Aggression - physiology; Aggressiveness; Antipsychotic Agents - therapeutic use; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain - blood supply; Brain - pathology; Brain - physiopathology; Cerebral palsy; Disease Progression; Functional Laterality - physiology; Hemianopsia - etiology; Hemianopsia - pathology; Hemianopsia - physiopathology; Humans; Infarction, Posterior Cerebral Artery - complications; Infarction, Posterior Cerebral Artery - pathology; Infarction, Posterior Cerebral Artery - physiopathology; Limbic System - blood supply; Limbic System - pathology; Limbic System - physiopathology; Male; Medical sciences; Mental Disorders - etiology; Mental Disorders - pathology; Mental Disorders - physiopathology; Neurology; Occipital Lobe - blood supply; Occipital Lobe - pathology; Occipital Lobe - physiopathology; Pharmacology. Drug treatments; Posterior Cerebral Artery - anatomy & histology; Posterior Cerebral Artery - pathology; Posterior Cerebral Artery - physiopathology; Predictive Value of Tests; Prospective Studies; Stroke; Temporal Lobe - blood supply; Temporal Lobe - pathology; Temporal Lobe - physiopathology; Thalamus - blood supply; Thalamus - pathology; Thalamus - physiopathology; Tomography, X-Ray Computed; Vascular diseases and vascular malformations of the nervous system; Visual Pathways - blood supply; Visual Pathways - pathology; Visual Pathways - physiopathology; Vascular disease; Stroke; Nervous system diseases; Central nervous system disease; Cardiovascular disease; Behavior; Posterior cerebral artery; Cerebrovascular disease; Cerebral disorder
• ISSN: 0003-9942; 2168-6149; 1538-3687; 2168-6157
• DOI: 10.1001/archneur.64.7.1029

OBJECTIVE To describe the mechanisms leading to aggressive behavior among patients with acute posterior cerebral artery stroke. DESIGN, SETTING, AND PATIENTS We prospectively included all of the patients with posterior cerebral artery stroke and aggressive behavior admitted to our department from January 1, 2003, to December 31, 2004. Patients with history of stroke, cognitive impairment, or prior history of psychiatric disease were excluded. RESULTS Aggressive behavior was found in 3 patients (7.3%) among 41 patients with posterior cerebral artery stroke. One patient had right occipitotemporal and ventrolateral thalamic stroke. The second patient had left occipitotemporal and lateral thalamic stroke. The third patient had right isolated occipital stroke. In addition to a contralateral homonymous hemianopsia, the patients, who were physically and emotionally balanced before the stroke, suddenly manifested an acute, unusual, aggressive behavior. The patients became agitated and aggressive when they were stimulated by the environment, and they responded to solicitations by their relatives or medical personnel by shouting obscenities and hitting and biting others. In all of the 3 cases, temporary physical restraint was required and neuroleptics were administered. This unusual behavioral pattern resolved within 2 weeks after stroke. CONCLUSIONS Aggressive behavior is a rare presentation of acute posterior cerebral artery stroke, which may be difficult to diagnose in patients presenting with hemianopsia as the only concomitant neurological sign. The postulated mechanisms include dysfunction of the limbic or serotoninergic system.Arch Neurol. 2007; 64:(7)938-944-->