Neurologists are trained to detect subtle sensorimotor deficits as manifestations
of stroke. The slightest facial asymmetry, a faintly clumsy hand, the minimal visual
field defect of a superior quadrantanopsia, transient perioral numbness, or even slight
slurring of speech are correctly elicited and identified as telltale signs of stroke
requiring urgent treatment. Nevertheless, when the relatives of an older patient mention
the recent occurrence of changes in behavior, mood, or cognition—profound apathy,
anger, uncharacteristic aggressiveness, depression, problems completing domestic tasks—most
stroke neurologists exhibit an enlarged blind spot to these “nonneurological” prefrontal
manifestations. The symptoms are either summarily dismissed off or, in the best of
cases, referred to a psychiatrist for evaluation.
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© 2006 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
