title: Late-onset recurrent mania as a manifestation of Wallenberg syndrome: a case report and review of the literature.
abstract: OBJECTIVE
  The aim of the present case report was to describe the late onset of recurrent mania in a patient after ischemic injury to the cerebellum and dorsolateral medulla.
  
  
  METHODS
  We studied an 86-year-old male with no prior psychiatric history who developed recurrent episodes of mania following a brain stroke. Additionally, he had neurological symptom constellation typical of Wallenberg syndrome.
  
  
  RESULTS
  Magnetic resonance imaging of the brain revealed infarction in the inferomedial right cerebellar hemisphere and the right dorsolateral medulla in the right posterior inferior cerebellar artery (PICA) distribution. He was successfully managed with a combination of antipsychotic and mood-stabilizer medications.
  
  
  CONCLUSIONS
  Post-stroke mania may be one of the rare manifestations of Wallenberg syndrome. This case adds to the emerging literature on cerebellar involvement in mood regulation and pathology of mania.
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.|Mental Health Clinic, VA Medical Center, Grand Island, USA.|Department of Psychiatry, Creighton University Medical Center, Omaha, NE, USA.
authors.forename: Piyush
authors.initials: P
authors.lastname: Das
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.|Department of Psychiatry, Allegheny General Hospital, Pittsburgh, PA, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Chopra
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.|Department of Psychiatry, St. Mary Mercy Hospital, Livonia, MI, USA.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Rai
authors.affiliation: Department of Psychiatry and Psychology, Mayo Clinic College of Medicine, Rochester, MN, USA.
authors.forename: Preetha Sharone
authors.initials: PS
authors.lastname: Kuppuswamy
mesh_terms: D000369:Aged, 80 and over; D014150:Antipsychotic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D001933:Brain Stem / Q000473:pathology*; D059907:Functional Neuroimaging / Q000379:methods; D006801:Humans; D014854:Lateral Medullary Syndrome / Q000150:complications / Q000175:diagnosis / Q000523:psychology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D012008:Recurrence; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents
keywords: bipolar disorder; cerebellum; mania; stroke