Right frontal injury often has been associated with development of manic behavior. Reports of similar behavior change with left-sided frontal damage are rare. We report a patient who developed hypomania after removal of an arteriovenous malformation (AVM) from the left frontal lobe.

OBJECTIVE: The aim of this preliminary pilot study was to investigate the safety and efficacy of open-label nadolol as an adjunctive pharmacological treatment for aggression and/or inattention/overactivity in a developmentally delayed child, adolescent, and young adult population. METHOD: Twelve subjects enrolled and completed (mean age 13.8 years, range 9 through 24) a 5-month, open, prospective protocol of nadolol (mean dose 109 mg, range 30 through 220 mg) with systematic baseline and outcome evaluations and weekly clinical assessment. RESULTS: All subjects were developmentally delayed and most were cognitively delayed. Ten subjects (83%) showed clinical improvement while receiving nadolol. Significant improvements were noted on observer-rated overt categorical aggression, severity of illness, and global impressions of improvement. No significant effects were found for inattention/overactivity. Nadolol was well tolerated, with few side effects. CONCLUSIONS: Overt categorical aggression presenting in developmentally delayed children, adolescents, and young adults may respond to nadolol treatment.

Risk factors for neuroleptic withdrawal dyskinesia in children have not been well studied. The authors present a case of a child who had been treated with a combination of neuroleptics and stimulants for nonpsychotic aggressive behavior. A severe withdrawal dyskinesia precipitated by neuroleptic tapering was ameliorated by discontinuation of the psycho-stimulant. Although stimulants have been reported to increase certain involuntary movement disorders, this is the first known report of psychostimulant exacerbation of withdrawal dyskinesia.