Nagaratnam Nages, Wong Ka-Kit, Patel Ilesh
Department of Medicine, Aged Care and Rehabilitation Services, Blacktown-Mount Druitt Health, Blacktown, NSW 2148, Australia.
Arch Gerontol Geriatr. 2006 Sep-Oct;43(2):223-32. doi: 10.1016/j.archger.2005.10.009. Epub 2005 Dec 7.
The concept of secondary mania continues to be debated together with unresolved or partially resolved issues such as lateralization, localization, age of onset, disinhibition syndromes, and others. We have described two patients with secondary mania following a stroke. One had a large left hemisphere cerebral infarction and the symptoms arose about 2.5 years later, possibly triggered by a transient ischemic attack involving the right hemisphere. The other had an infarction in the right posterior artery territory extending to the thalamus and internal capsule together with infarctions in the deep border zones of both hemispheres at the level of the centrum semiovale with the manic symptoms concomitant with the onset of the event. The clinical and neuro-anatomic mechanisms that underlie the diverse locations of secondary mania are discussed. The cerebral components of secondary mania and disinhibition syndromes are very similar and it is proposed that disinhibition syndromes, secondary hypomania and secondary mania with and without psychotic symptoms are simply a continuum of severity of mood disorder and secondary mania with psychotic symptoms may be an extreme form. The concept of secondary mania in the elderly is not likely to disappear although several unresolved issues remain. For the neurophysician, geriatrician, and the psychiatrist there is much to be attained by simplifying the issues and accepting the view that secondary mania is a discrete entity.
继发性躁狂症的概念仍在持续争论中，同时还存在一些未解决或部分解决的问题，如大脑半球优势、定位、发病年龄、去抑制综合征等。我们描述了两名中风后继发性躁狂症患者。一名患者左大脑半球有大面积脑梗死，症状在约2.5年后出现，可能由涉及右半球的短暂性脑缺血发作引发。另一名患者右后动脉区域梗死并延伸至丘脑和内囊，同时在半卵圆中心水平的双侧大脑半球深部边缘区也有梗死，躁狂症状与发病同时出现。本文讨论了继发性躁狂症不同发病部位背后的临床和神经解剖学机制。继发性躁狂症和去抑制综合征的大脑组成部分非常相似，有人提出，去抑制综合征、继发性轻躁狂症以及伴有或不伴有精神病症状的继发性躁狂症只是情绪障碍严重程度的一个连续体，伴有精神病症状的继发性躁狂症可能是一种极端形式。尽管仍有一些未解决的问题，但老年人继发性躁狂症的概念不太可能消失。对于神经科医生、老年病医生和精神科医生来说，简化这些问题并接受继发性躁狂症是一个独立实体的观点将大有裨益。
