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GRADUAL changes in behavior after a stroke?

Dear post reader,

My mother had some serious changes in her behavior lately and I am puzzled about her situation. It is a complicated matter, as there can be multiple causes for those changes. The most obvious possible cause is that she had a stroke (blood clot coming from her heart) three months ago (on the young age of 56). However, three days before the stroke, as a coincidence, the antidepressants she was taking for her second depression finally seemed to work. Now she is diagnosed with bipolar disorder by her psychotherapist, a disorder her father also had. The idea that my mother has a bipolar disorder is not new to us: even before her stroke, with her first depression and recovery from it, we noticed her behavior sometimes resembled this of her father.

So, I see roughly two possible causes for her behavior: one is the stroke and the second is her bipolar disorder getting out of hand (due to sleeping disorder and/or new antidepressants).

Part of the changes in behavior I am talking about are: being very impulsive and commanding, being hyperactive and talking slowly, spending a lot of money on useless things and acting euphoric. These changes were seen immediately after the stroke. The tricky thing is: I observed the same changes after her first depression, so before her stroke. However, this time, after her second depression, they looked more extreme than the first time.

You see, it is difficult to conclude what the real cause is. But here is a curious thing I have to add: in the last three months, her behavior changed even more, gradually. She became more and more messy and developed a compulsive hoarding. While she claims she is "structuring her books and papers", she puts them all around the house, on the sofa, on the bed,... mostly at night btw. She also got aggressive. She is shouting bad words to my father and sister, something she never did before. In only happened last weeks, more than two months after her stroke. Also, she became more obsessed by little things like letters on the box of milk and she visits the neighbors more than 20 times a day, all behavior that is completely new to us. And, what worries me even more, last week, she was getting out the house in her pyjamas, ran on the street and stopped some cars there for unknown reason. She is not aware anymore of all she does, as she can not remember those things.

Therefore I am searching for the answer on those questions:
-Is it common for patients to change their behavior gradually after a stroke, like my mother did?
-What looks the most likely: that this gradual change in behavior is due to one stroke only or due to her bipolar disorder?

Any reactions will be greatly appreciated.
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replied February 25th, 2011
Hello and thank you for posting your medical question on E health forum.

From the history provided, most of the findings in your mother are associated with her bipolar disorder rather than that due to stroke.

For your information, Vision changes, Loss of memory, Personality changes, Mood changes (depression, apathy), Drowsiness, lethargy and unconsciousness are some major symptoms seen in stroke patients in the later stages after an episode of stroke.

Stroke patients over time develop dementia and can have a labile emotional status. This means that they can start crying for no reason as well. This is a very common feature that is not to be worried about.

Family counseling may help in coping with the changes required for home care of the patient. Visiting nurses or aides, volunteer services, homemakers, adult protective services, and other community resources may be helpful in the management of stroke patients.

You might consider getting him evaluated by a psychiatrist, who can rule out conditions like depression and start essential treatment at the earliest.

I hope this helps

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