Post-stroke depression is common. In contrast, mania after stroke is rare.

case report.

Mr A., a 55 years old, right handed man, presented sudden non fluent aphasia during 10 minutes, investigated in an emergency department. Computed tomography (CT) revealed focal atrophy in the right temporal cortex. According to the general practitioner and the emergency department, the patient developped mania within 24 hours, characterized by psychomotor agitation, insomnia, distractibility, irritable affect, disorganised thought, and flight of ideas. He was admitted in our psychiatric department without consent 9 days later. He fullfilled DSM-IV criteria of manic episode. The patient was correctly orientated. Cognitively, the patient was able to score 28 out of 30 on the Mini-Mental State Examination. He was being treated for hypertension and diabetes by his general practitioner for 10 years. There was no family history of psychiatric disorder. His treatment included amlodipine 10 mg/day, trinitrine 5 mg/day, and glibenclamide 5 mg/day. A second CT scan showed ischemic focal change in the right temporal pole. B12 and folates levels were within the normal range. The patient tested negative for the syphilis serology. He received valproic acid 900 mg/day and had a good response. Over a 15-day period, his elevated mood settled to an euthymic level. His daily medication included valproic acid, risperidone 2 mg and hydroxyzine 200mg.

Mania could be associated with right-hemisphere lesions, particularly in limbic areas that have strong connections with the frontal lobe (Starkstein & Robinson, 1997).