Self-reported aggressive behavior in patients with stroke.

This study represents a first attempt to identify some of the clinical and pathoanatomical correlates of violent outbursts in patients with cerebrovascular accident. Subjects were selected from a population of patients hospitalized with acute stroke. Although we did not have behavioral measures of violent behavior, patients who reported having had violent outbursts were identified based on clinical ratings on a structured interview. Subjects were asked if they had experienced episodes of anger accompanied by behaviors ranging from shouting to violence during the time since their stroke. These patients were compared with controls matched for demographic variables. Violent patients had higher total Present State Exam and Hamilton-D scores. The percentage of patients with cognitive impairment in the angry outburst group (66%) was greater than the control group (22%). Outburst patients had a higher frequency of left-hemisphere lesions (46.7%) compared with controls (29.4%). When lesion volumes were statistically equated, proximity of lesion to the frontal pole was one of the factors related to the self-reported irritable/violent behavior. To determine whether depression explained our findings, we carried out two-way analyses of variance with angry outburst and major depression group membership as factors. Effects of left anterior lesion location and cognitive impairment on violence remained present. These findings suggest that the potential for anger and violence in patients with stroke has multiple clinical and neuropathological correlates, including greater cognitive impairment and left anterior hemisphere lesions.