Recurring episodes of Bell's mania after cerebrovascular accident.
BACKGROUND
Bell's mania (mania with delirium) is an acute neurobehavioral syndrome of unknown etiology that is characterized by the rapid onset of grandiosity, psychomotor excitement, emotional lability, psychosis, and sleep disruption consistent with mania, coupled with alterations in sensorium, and disorientation characteristic of delirium. Catatonia is a common feature of the syndrome.


METHODS
The authors describe a case of recurrent delirium/mania with prominent catatonic features after a cerebellar and pontine stroke, and subsequent successful treatment with lorazepam.


RESULTS
Symptoms quickly resolved after antipsychotics were discontinued, with continuation of valproate and lorazepam treatment.


CONCLUSIONS
Failure to recognize this patient's syndrome as a form of catatonia could have had severe, even life-threatening, consequences. The use of neuroleptic medications in cases of delirium/mania with catatonic signs may result in marked clinical deterioration, whereas high-dose lorazepam can ameliorate catatonic signs.
Bobo
William V
WV
Dept. of Psychiatry, Vanderbilt Univ. School of Medicine, Vanderbilt Psychiatric Hospital, Suite 3035, 1601 23 Ave. South, Nashville, TN 37212, USA. william.v.bobo@vanderbilt.edu
Murphy
Michael J
MJ
Heckers
Stephan H
SH
D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D020526:Brain Stem Infarctions / Q000150:complications* / Q000523:psychology; D002389:Catatonia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D002531:Cerebellum / Q000098:blood supply*; D003693:Delirium / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology* / Q000523:psychology; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008140:Lorazepam / Q000627:therapeutic use*; D008875:Middle Aged; D011149:Pons / Q000098:blood supply*; D012008:Recurrence
D014151:Anti-Anxiety Agents; D008140:Lorazepam