Introduction

Although recognized as early as 1924 by Bleuler, depression and, more generally, mood disorders following cerebral lesions have only been studied systematically in the last 20 years. Initial studies of emotional disorders in brain injuries included patients with various lesions such as surgical incision, traumatic closed head injuries, penetrating head injury and stroke making it difficult to determine the location of the lesion. Some more recent stroke studies suggest a critical role of the anterior left hemisphere in depression, but other authors deny causal contribution of lesion location to depression. The predominant role of the right hemisphere in secondary mania is well recognized, but a consensus is still lacking and further studies are needed to determine the clinico-topographic correlation of disorders, such as apathy, anxiety, catastrophe reaction and pathological laughing and crying sometimes encountered after stroke. These affective disorders are important to consider in stroke patients, since they may negatively influence neurological recovery and may be responsive to treatment.

Specific emotional behaviours, such as disinhibition, denial, indifference, overt sadness and aggressiveness, often occur during the very first days following stroke. They might be overlooked if not searched for systematically with appropriately designed scales. Some of these early behaviours, such as denial, may be related to the late development of depression and anxiety. Prospective studies of mood changes during and immediately after stroke have not been performed yet. Such studies on large samples of patients may permit the delineation of which of these acute emotional behavioural changes are markers for the delayed development of emotional disturbances (Ghika-Schmid & Bogousslavsky, 1997).