Euphoria is characterized by a feeling of well-being, cheerfulness, and optimism. It can be constant or intermittent. It may be psychogenic or organic. The mnemonic VINDICATE will help recall the many causes of euphoria.
· V—Vascular. Cerebral arteriosclerosis and stroke are rarely a cause of euphoria.
· I—Inflammation. Aside from patients with general paresis or a frontal lobe abscess, euphoria is also rarely associated with an infectious disease process.
· N—Neoplasm. This should bring to mind frontal lobe tumors in which the patient is not only euphoric but exhibits excessive jocularity, lack of insight, and poor memory for recent events.
· D—Degenerative. In some cases of dementia, euphoria may present at the outset.
· I—Intoxication. Drugs such as amphetamines, lysergic acid diethylamide (LSD), and corticosteroid may produce a euphoric state. Cocaine and other narcotics may do the same.
· C—Congenital. Patients with cerebral palsy and other congenital disorders of the brain may exhibit euphoria.
· A—Autoimmune. Multiple sclerosis is associated with euphoria in many cases.
· T—Trauma. This brings to mind the euphoria associated with a concussion and post-traumatic neurosis.
· E—Endocrine. Hyperthyroidism and Cushing syndrome may be associated with euphoria, but depression is much more likely.
Unfortunately, the mnemonic VINDICATE fails to remind us of psychogenic causes such as schizophrenia, manic-depressive psychosis, and psychopathic behavior disorders. Temporal lobe epilepsy may be associated with intermittent euphoria.
Approach to the Diagnosis
Look for a history of drug use or abuse. A careful mental status examination may suggest early Alzheimer disease or other forms of dementia. Neurologic examination may show bilateral pyramidal tract signs indicating multiple sclerosis or papilledema indicating a brain tumor.
A venereal disease research laboratory (VDRL) test or urine drug screen may suggest the diagnosis. A neurologic consult should be ordered before proceeding with expensive tests such as a CT scan or MRI. Perhaps a psychiatrist should be consulted early in the workup.
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