Table 3.
Mania in patients with Vascular Dementia (VaD) and Vascular Cognitive Impairment (VCI).
| References | Age | Sex | Family History | Somatic Comorbidity | Antecedents (onset) | CVE | VCI (onset) | CT/MRI Findings | Concomitant Drugs | Treatments |
|---|---|---|---|---|---|---|---|---|---|---|
| Cortico-subcortical VCI (Due to Large Vessel Disease) | ||||||||||
| Damodaran et al. (1994) [55] | 40 | M | None | - | Depressive episode (38 y) |
- | Gradual cognitive decline (40 y) | Two small lesions in the frontal lobes, one in the deep left parietal lobe | Imipramine, thioridazine | Antipsychotics and lithium (wandering and confusion appeared) |
| Watanabe et al. (2006) [52] | 64 | M | - | Hypertension, diabetes, cardiac diseases | BD 2 (40 y) | Left frontotemporal lobe infarction (62 y) | VaD (2 months before mania) | Left frontotemporal lobe encephalomalacia; moderate cortical atrophy | - | - |
| Duggal and Singh (2009) [57] | 47 | M | None | Diabetes | Chronic depression (35 y) | Left inferior frontal region infarct (46 y) |
VaD (5 months before mania) |
Encephalomalacia and ischemic changes in WM and basal ganglia | Benzodiazepines, opioids, bupropion (chronic treatment) | Ziprasidone, carbamazepine, donepezil, discontinuation of bupropion |
| Duan et al. (2018) [37] | 73 | F | None | Atrial fibrillation |
Recurrent depression (33 y) | Right cerebellar hemisphere, left occipital lobe, and left pons cerebral infarctions (69 y) | Vascular cognitive impairment (73 y) | Multiple encephalomalacias; ischemic changes in bilateral periventricular regions and bilateral centrum semiovale | Venlafaxine and quetiapine (chronic treatment) | Discontinuation of venlafaxine; quetiapine increase (no response); donepezil and memantine (worsening); resolution with lithium carbonate |
| Subcortical VCI (Due to Small Vessel Disease) | ||||||||||
| Iijima et al. (1993) [51] | 65 | F | Mental retardation | - | None | TIAs (> 55 y) |
VaD (69 y) | Bilateral and symmetrical WM ischemic changes (Binswanger’s disease) | - | - |
| Senturk et al. (2006) [56] |
60 | F | Major depression | - | Major depression (59 y) | - | Cognitive dysfunction (60 y); VaD (61 y) | Atrophy and multiple ischemic gliotic lesions in the periventricular subcortical WM, basal ganglia, and pons | Antidepressant discontinuation 3 months before mania | VPA and BDZ (partial response); resolution with clozapine (depressive symptoms appeared) |
| VCI due to CADASIL | ||||||||||
| Kumar and Mahr (1997) [58] | 55 | M | CADASIL | - | Alcohol abuse | - | Little evidence of cognitive impairment | Ischemic changes in the periventricular and subcortical WM of both cerebral hemispheres, corona radiata, centrum semiovale bilaterally, both basal ganglia, pons, and thalami | - | - |
| Leyhe et al. (2005) [59] | 60 | M | Stroke, dementia, migraine | - | - | - | Executive and attention deficits (60 y) |
Severe confluent leukoencephalopathy with single lacunar infarcts and microbleedings in the basal ganglia | - | Pipamperone |
| Park et al. (2014) [53] | 53 | F | Depression, suicide | Hypertension, diabetes | Personality changes started (48 y) |
- | Executive and attention deficits | Severe leukoencephalopathy, ischemic changes in the peri- ventricular white matter, basal ganglia, thalamus, and the external capsule | Antidepressants and hypnotics (chronic treatment) | Quetiapine and BDZ (partial response) |
| Bangash and Saad (2016) [54] | 58 | F | None | - | None | TIAs (57 y) | Memory and visuospatial reasoning deficits (58 y); VaD (59 y) |
Ischemic changes in the subcortical, periventricular and deep WM, in the pons, bilateral inferior temporal lobe, and posterior fossa | None | Olanzapine (relapse); aripiprazole (relapse); resolution with VPA |
| Uppal et al. (2020) [60] | 64 | F | - | TBI with subdural hematomas | Depression, alcoholism and personality change (> 40 y) | - | Executive deficits | Ischemic changes in the supratentorial and infratentorial WM, chronic haemorrhagic infarctions in the frontal, and temporal lobe | Amphetamine dextroamphetamine (chronic treatment) | Discontinuation of stimulants; quetiapine, and lithium |
| Okamoto et al. (2021) [68] |
80 | F | - | Hypertension, uterine fibroids | Personality changes (79 y) |
- | Attention deficits and poor judgment (79 y) | Chronic ischemic changes in bilateral temporal and occipital lobes, right subcortical frontal lobes, and right illuminating hemisphere. Atrophy of the medial temporal lobe | - | Resolution with VPA |
Abbreviations: BD 2 = Bipolar disorder type 2, BDZ = Benzodiazepines, CADASIL = Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy, CT = Computerized tomography, CVE = Cerebrovascular event, F = Female; M = Male, MRI = Magnetic resonance imaging, TBI = Traumatic brain injury, TIA = Transient ischemic attack, VaD = Vascular dementia, VCI = Vascular cognitive impairment, VPA = Valproic acid, WM = White matter, y = years.