Background and Purpose: Post-stroke mania is thought to be rare, and has been described after lesions in the territory of the left medial cerebral artery, biparietal cortex, and the left putamen.

Methods: Case-study methodology was used to identify similarities and difference among six cases of post-stroke mania in a rural, community hospital over 1 year.

Results: All patients had pre-existing moderate levels of small vessel occlusive disease and two had confirmed lacunar infarcts in the basal ganglia, while one had a small left sided fronto-parietal infarct consistent with the dysarthria-clumsy hand syndrome. Stroke was not initially recognized among these patients due to the absence of acute Computed Tomography (CT) findings. Patients without pre-existing psychiatric diagnoses responded to low dose quetiapine. Two patients with pre-existing diagnoses of depression and anxiety, required higher doses.

Conclusion: Post-stroke mania may be under-appreciated due to the subtle neurological findings inherent to basal ganglia and/or lacunar infarcts in other locations. Acute CT is not reliable enough to confirm the diagnosis of stroke which may allow many of these cases to be missed.