Post-stroke emotionalism; diagnosis, pathophysiology, and treatment.

Post-stroke emotionalism affects 1 in 5 stroke sufferers 6 months after their stroke, but despite its frequency remains a poorly understood stroke symptom. The literature is limited, especially compared to other frequently observed neurological conditions such as aphasia and visual neglect. This narrative review presents a summary of this literature, to inform clinical practice and future research. We cover discussion of definitions, prevalence, neurobiology, predisposing and precipitating factors, and treatment. Increasing evidence suggests that damage to specific areas functionally linked to emotion expression or regulation processes, disruption to structural pathways, and disruption to related serotonin production and modulation individually or in concert give rise to emotionalism-type presentations. A range of emotionalism measurement tools have been used in research contexts making between study comparisons difficult. The Testing for Emotionalism after Recent Stroke - Questionnaire (TEARS-Q), has recently been developed to allow standardised assessment. Treatment options are limited and there have been few adequately powered treatment trials. Antidepressants may reduce severity, but more trial data are required. There have been no randomised controlled trails of non-pharmacological interventions. More research is needed to improve recognition and treatment of this common and disabling symptom. We conclude with research priorities and recommendations for the field.