Bithalamic Infarction Presenting as Postpartum Psychosis: Case Report

Postpartum ischemic stroke associated with acute psychosis is a rare but potentially serious occurrence, with an increased risk in the postpartum period. Bilateral thalamic infarction occurs when the artery of Percheron is occluded and presents vague neuropsychological signs, memory loss, executive dysfunction, and sleeplessness. The association between ischemic stroke and acute psychosis in the postpartum period is rare and has not been described in the literature. We report the case of a 36-year-old woman with no history of psychiatric illness, who presented four weeks postpartum with an acute onset of psychosis with sleeplessness, disorientation, forgetfulness. Brain Magnetic Resonance Imaging (MRI) revealed bilateral thalamic infarction. Although investigations supported thyrotoxicosis as a possible contributor, the exact stroke mechanism in this case remained undetermined mainly due to absence of detailed diagnostic investigations. Treatment with antipsychotics controlled acute psychosis, but speech loss and memory dysfunction persisted. Symptom control of the thyrotoxic phase with beta blockers and secondary prevention of stroke with low-dose aspirin and statins led to symptom improvement. This case highlights the need to consider the evaluation for organic neurological disease in postpartum psychosis and not limited to psychiatric causes. Stroke in the postpartum period may present with nonfocal symptoms, and thus heightened clinical awareness is essential.