Stroke

A stroke (also called a cerebrovascular accident, CVA) is an acute disturbance of the cerebral perfusion or vasculature. Approximately 85% of strokes are ischemic (blockage of a vessel) and remainder are hemorrhagic. Post-stroke, individuals are at risk for developing neuropsychiatric syndromes such as post-stroke depression and pseudobulbar affect.

For a detailed approach to diagnosing, managing, and follow up of stroke presentations, see the above main article.

• Following a stroke, the onset of depression can be acute, usually occurring within 1 day or a few days of the cerebrovascular accident (CVA).^[1]
• Approximately 33% of stroke survivors develop PSD at some point, with the frequency being highest in the first year of stroke (and declines thereafter).

Pseudobulbar affect (PBA) (also known as emotional lability, reflex crying or laughing, emotional incontinence, and involuntary emotional expression disorder) is a neuropsychiatric syndrome common in neurological disorders including stroke, amyotrophic lateral sclerosis (ALS), Parkinson’s, traumatic brain injury, multiple sclerosis, dementia, Wilson’s disease, and brain tumors. PBA is not a mood disorder, but rather an abnormal display of affect that does not match an individual’s true (internal) feelings.

• Nagaratnam, N., Nagaratnam, K., Ng, K., & Diu, P. (2004). Akinetic mutism following stroke. Journal of Clinical Neuroscience, 11(1), 25-30.