Maria João Freire
OBJECTIVES: Case report of a severe depressive episode with suicidal ideation immediately after a stroke in an elderly patient with no psychiatric history. Revision of literature. BACKGROUND AND AIMS: Post-stroke depression (PSD) is a frequent complication of stroke, correlating with higher disability and mortality, and mainly occurs within the first 6 months. The etiological mechanism is undetermined ‒ several lesion locations have been implicated (left lenticulocapsular area, frontal-subcortical circuits) but the results are contradictory. MATERIALS AND METHODS: Anamnesis and literature revision using PubMed and the keywords “depression” and “stroke”. RESULTS: The case is an 82-year-old man brought to the Psychiatric Emergency Department after two suicide attempts in the span of seven days. He was severely depressed, with ideas of ruin, insomnia, anorexia and structured suicidal ideation. The week before, he had suffered a stroke affecting the anterior portion of the left cingulate gyrus that left him with mild right hemiparesis and paresthesia. The psychiatric symptoms developed immediately after the stroke and were not present before the event; the patient had no personal of familial psychiatric history. He was admitted to the Psychiatry Ward, treated with sertraline 100mg/day and quetiapine 50mg/day and was discharged within 28 days, after full remission of symptoms. CONCLUSIONS: The etiology of PSD is not completely understood. The presented case stands out by the suddenness and severity of symptoms, suggesting that lesions to the left cingulate gyrus, a region closely linked to mood regulatory circuits, may play a role in the development of PSD.
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