An 81-year-old woman with postmenopausal onset of a bipolar disorder had multiple individual manic and depressive episodes over the span of 31 years. Autopsy disclosed widespread periventricular demyelinated plaques. Although the late age at onset of bipolar symptoms suggested an underlying organic disorder, the multiple affective episodes and lack of additional neurological manifestations make the case atypical. The authors stress the use of modern imaging modalities such as MRI in investigating secondary mood disorders.
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