We have reported a unique example of an organic affective syndrome in a patient who had focal brain lesions, but whose initial neurologic examination was nonfocal. In retrospect, the only clue to an organic disorder was hyperreflexia in this patient with a history of alcohol abuse and clinical signs of a distal sensory neuropathy. This case emphasizes the importance of pursuing a neurologic work-up (including CT scan) in older patients with sudden mood changes, even in the absence of focal neurologic findings.
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