Botez Stephan A, Carrera Emmanuel, Maeder Philippe, Bogousslavsky Julien
Department of Neurology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Arch Neurol. 2007 Jul;64(7):1029-33. doi: 10.1001/archneur.64.7.1029.
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.
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 solicitation 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.
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.
描述导致急性大脑后动脉卒中患者出现攻击性行为的机制。
设计、地点和患者：我们前瞻性纳入了2003年1月1日至2004年12月31日期间入住我科的所有大脑后动脉卒中和有攻击性行为的患者。排除有卒中史、认知障碍或既往精神疾病史的患者。
41例大脑后动脉卒中患者中有3例（7.3%）出现攻击性行为。1例患者有右侧枕颞叶和丘脑腹外侧卒中。第2例患者有左侧枕颞叶和丘脑外侧卒中。第3例患者有右侧孤立性枕叶卒中。除对侧同向性偏盲外，这些在卒中前身心状态平衡的患者突然表现出急性、异常的攻击性行为。患者在受到环境刺激时变得烦躁和具有攻击性，对亲属或医护人员的招呼会以辱骂、殴打和咬人回应。所有3例患者均需临时身体约束并给予抗精神病药物。这种异常行为模式在卒中后2周内消失。
攻击性行为是急性大脑后动脉卒中的一种罕见表现，对于仅伴有偏盲这一唯一伴随神经体征的患者可能难以诊断。推测的机制包括边缘系统或5-羟色胺能系统功能障碍。
