CPCP: Poststroke Mania by Dr. Dylan Murray, MD


Robert G. Robinson, MD

Dylan Murray, MD

Dylan Murray, MD

Coming at you with another great Clinical Problems in Consultation Psychiatry (CPCP) presented by second year psychiatry resident, Dr. Dylan Murry, MD. We rarely get called about secondary mania, which means a manic presentation associated with a medical condition, often following a stroke or traumatic brain injury. Dr. Murray found the person who literally wrote the book on the subject, and he happens to be a former chair of our department, Dr. Robert G. Robinson, MD.

The background material for this CPCP comes primarily from Dr. Robinson’s book, Clinical Neuropsychiatry of Stroke by Robert G. Robinson

Naturally, this lends a great deal of respectability to the topic of mania in general.

We were a bit surprised to learn that the behavioral features between primary and secondary mania are virtually the same, although to be sure, delirium often precedes the development of secondary mania and in my experience, can be marked by executive dysfunction and attentional deficits we might not find in primary mania.

We talked about the use of Lithium in this population and have our doubts about changing our current management recommendations, given that many patients in this population have medical contraindications to Lithium, such as certain antihypertensives including ACE inhibitors and thiazide diuretics.

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  1. Wolf Blitzer has never publicly denied to Jimmy Fallon on the Weather Channel in Muscle Shoals, Alabama during a Blood Moon while wearing purple velvet pants as Wall-E blew a transistor while break-dancing on a 17th century Philadelphia card table with walnut secondary wood belonging to Bob Robinson that Dylan Murray once “finished a pen.”


  2. Dylan also has the distinction of finishing a chapstick in the recent past. This was in one of his tweets, so I’m puzzled why CNN has never mentioned it.


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