Restlessness with manic episodes induced by right-sided multiple strokes after COVID-19 infection: A case report

Ischemic stroke is a major complication of coronavirus infection 2019 (COVID-19). During the COVID-19 pandemic, multiple strokes occurred in many elderly people. Among them, poststroke mood disorders such as depression are relatively common. However, restlessness with manic episodes has rarely been reported. We experienced an elderly patient who became manic shortly after recovering from COVID-19 infection, which turned out to be right-sided multiple strokes. The manic state improved as the strokes stabilized, suggesting that impaired blood flow was the cause of the manic symptoms. Primary mania increases blood flow in the left hemisphere, whereas right-sided strokes may relatively increase blood flow in the left hemisphere, which may have induced manic symptoms in this case. Multiple right-sided strokes after COVID-19 infection can cause mania, and the mechanism of poststroke mania needs to be investigated in the future.