Posterior cerebral artery stroke presenting with acute onset psychosis in an elderly woman

Abstract Psychiatric illness, acute or subacute, may be an indicator of neurological disorders, particularly a stroke or tumor in the occipital and or temporal cortex. Posterior cerebral artery (PCA) territory stroke is a common and important neurological illness masquerading an acute or subacute onset psychosis in the form of visual hallucinations, particularly in elderly people with vascular risk factors. We depict here a patient with acute onset psychosis presenting with visual hallucinations and aggressive behavior without any previous history of psychosis in a 78 yr old hypertensive and diabetic woman whose illness was eventually attributed to a subacute ischemic infarct in her distal right PCA territory. Being aware of the visual hallucinations, she showed anxious and aggressive behavior. An immediate MRI brain was done which revealed subacute infarct in distal right PCA territory - the occipital (striate and peristriate) cortex with a central area of hemosiderin deposition. Reassurance and modest doses of antipsychotic drug with statin, antihypertensive and oral hypoglycemic agent (OHA) resulted in gradual amelioration of her symptoms.