Bipolar syndromes following brain trauma

Abstract

A number of illnesses can produce mood abnormalities. Case reports suggest that syndromes resembling Idiopathic bipolar disorders can follow traumatic brain injuries (TBI). We describe a TBI patient who developed episodes of depression and mania after his injuries and review the recent literature on post-traumatic bipolar syndromes. While unipolar depression is common after TBI, bipolar syndromes occur in only a small segment of the TBI population. A bipolar syndrome can appear immediately after a TBI or after a delay of months or years. Patients with post-traumatic mania are often irritable and aggressive. Factors that may predispose a TBI patient to bipolar illness include an inherited vulnerability to mood disorders, pre-existent frontal subcortical and diencephalic atrophy, and post-traumatic seizures. Studies of patients who developed a bipolar syndrome after a brain Insult show a preponderance of right hemisphere lesions, particularly right orbitofrontal and basotemporal cortical, caudate and thalamlc lesions. Right cortical leslons can produce unipolar mania, and right subcortical lesions can produce mania and depression. Right basotemporal cortical dysfunction may play an important role In both primary and post-traumatic bipolar syndromes. Patients with post-traumatic bipolar syndromes can be treated effectively with medication or electroconvulsive therapy.