Behavioural and psychiatric aspects of silent cerebral infarction.

A number of psychiatric and behavioural symptoms have been described in relation to silent cerebral infarction. At least four symptom clusters were identified, namely, affective, paranoid delusional, confusional state and changes in mood with behavioural disturbances. The mechanisms involved are unclear. Biochemical changes involving neurotransmitter mechanisms, vascular compromise or structural damage to the anatomical pathways may be contributory if not causal. It is clear that in patients presenting with behavioural or psychiatric manifestations without any previous history of mental illness and without any focal or lateralising neurological signs, cerebrovascular disease should be a diagnostic consideration.