the dominant motoric view of cerebellum has now changed to include its role in all cognitive functions and behavior as for the cerebral cortex .
lesions of the cerebral cortex producing secondary mania are commonly described , but cerebellar lesion producing mania is relatively uncommon .
this was a case report of a 28-year - old unmarried man from a rural low middle - income group , farmer by occupation presented to our out - patient department ( opd ) on 05.05.2008 with acute excitement and inability to walk .
although working in the fields the previous day , he had a feeling of giddiness and had projectile vomiting .
he could not sleep on the day of onset of his complaints . throughout the night he was disturbing others and demanding things .
he was talking spontaneously and excessively to everyone as if they were familiar to him .
he was expressing grandiose ideas that he has a lot of power and can even beat 500 men .
he lacked insight to his mental illness , but accepted his walking difficulty and said he wants medical attention .
there was mild slurring of speech , but the classical speech of cerebellar disorder was absent .
there was no history of fever , convulsions , incontinence , swallowing or visual difficulty .
urine examination , blood examination , including electrolytes , x - ray chest and skull were within the normal limits .
bender - gestalt test showed signs of organicity [ figure 1 ] . in young mania rating scale , he scored 32 .
bender - gestalt test drawing of the patient showing evidence of organicity like poor form level & poor relationship to one another and to the whole spatial background he was seen by neurologist twice and was diagnosed of having left cerebellar stroke .
computed tomography ( ct ) brain was done twice , which showed a hypodense lesion in left cerebellar hemisphere suggestive of vascular infarct [ figure 2 ] . magnetic resonance imaging ( mri )
he fulfilled the criteria to diagnose organic manic disorder  f06.30 as per icd 10 .
computed tomography of brain showing hypo dense lesion in left cerebellar hemisphere suggesting vascular infarct patient was followed - up in the next 1 month .
he was given tablet sodium valproate 200 mg 2 bd and tablet olanzapine 5 mg 2 bd and tablet diazepam 5 mg 2 h.
neuroimaging studies confirm that the cerebellum is activated milliseconds before cerebral activation in all aspects of cognitive function like memory and thinking as it is before motor movements .
cerebellum has rich to and fro connections not only to pyramidal areas but also to prefrontal lobe , temporal lobe , limbic area , cingulate gyrus , hypothalamus and thalamus .
the role of the cerebellum in cognition and behavior is gaining more and more importance now .
movement abnormalities in catatonia are again thought to be due to cerebellar and basal ganglia involvement .
they beautifully illustrated a patient aa who presented with cerebellar signs as well as symptoms of schizophrenia .
andreason suggests the presence of cognitive dysmetria due to cerebellar involvement in schizophrenia which is analogous to motor dysmetria so far described in cerebellar patients .
lauterbach analyzing 45 post - stroke patients noted mania in three patients who had lesions in left cerebellum or left cerebellar tracts to right caudate and thalamus .
unlike previous reports in literature , our patient is interesting in the sense that the cerebellar lesion has produced cerebellar and manic features simultaneously .
schmahman and sherman in his editorial in brain documents the evidence for the neuropsychological and behavioral involvement in cerebellar lesions .
he suggests that cerebellar lesions produce not only motor dysfunction but it produces a cerebellar cognitive affective syndrome .
its defining features are disturbances in executive function , spatial recognition , language and emotional regulation of behavior .
posterior lobe lesions produce core cerebellar syndrome , whereas vermian lesions produce pronounced affective disturbance .
now we recognize subcortical dementia and obsessive - compulsive disorder is due to basal ganglia lesions .
similarly , by analogy we should give more attention to the cerebellum for cognition and behavior .
contribution of the cerebellum to cognition and emotion can no longer be ignored . from a clinical perspective
, cerebellum has to be more closely looked for in ct and mri pictures of our patients .
we have to learn more about cerebellum and we should not confine it to only a minor motor role .
frick mentions that the cerebellum may form a major neurological component of the ego , particularly sub serving the autonomous ego functions . before concluding i shall quote what dow says about cerebellum in his book ,  just as cerebellum maintains motor balance it can as well balance other functions of brain of particular relevance to psychiatry . 
 secondary mania resulting from cerebral cortex are described commonly . 
 but secondary mania produced by cerebellar lesions are relatively uncommon . 
 this case report describes a patient who developed cerebellar stoke and manic features simultaneously . 
 28 years old male developed giddiness and projectile vomiting . 
 then he would lie down for about an hour only to find that he could not walk . 
 he became quarrelsome . 
 his psycho motor activities and speech were increased . 
 he was euphoric and was expressing grandiose ideas . 
 bender gestalt test showed signs of organicity . 
 score in young mania relating scale was 32 ; productivity was low in rorschach . 
 neurological examination revealed left cerebellar signs like ataxia and slurring of speech . computed tomography of brain showed left cerebellar infarct . 
 relationship between psychiatric manifestations and cerebellar lesion are discussed . 