Abstract
Background: Post-stroke mania and hemichorea due to corticostriatothalamocortical circuit dysfunction are extremely rare. The co-existence of mania and chorea as the chief presenting features of acute stroke has never been reported in the literature. Here we report a case of acute mania and left hemichorea following right putamen infarct.Case Presentation: A 66-year-old man with underlying hypertension presented with a 10-day history of sudden onset involuntary movements of the left limbs. His relative also reported abrupt changes in his mood and behaviour that occurred on the same day. There was no personal or family history of psychiatric illness. Examination revealed frequent, irregular, large amplitude choreiform movements in the left arm and leg, which present at rest and increased during voluntary actions. Psychological evalu-ation showed he was in manic state characterised by elated mood, inflated self-esteem, increased activity, loud and pressured speech, flight of thoughts and distractibility that fulfilled the DSM-V criteria for mania. Routine laboratory tests including fasting glucose, HbA1C and thyroid function test were normal. MRI scan obtained 12 days after onset demonstrated T2W/FLAIR hyperintense lesion located in the right putamen with no fluid restriction on cor- responding DWI indicating subacute infarct. He was started with oral antiplatelet and statin for the stroke. Following treatment with oral haloperidol with subsequent addition of oral sodium valproate as a mood stabiliser, his chorea and mania symptoms were markedly improved. He was discharged one week later with further improvement of symptoms at 4-week follow up. Conclusion: Our case describes acute mania and hemichorea as rare clinical manifestations after ischaemic stroke. Keywords: Ischaemic stroke, mania, hemichorea.