OBJECTIVE: The authors describe the case of a patient suffering from a persistent severe depressive episode with mood-congruent psychotic features following left temporal ischemia. BACKGROUND: Depression is a frequent disorder that may stem from psychosocial factors or occur after brain damage. Cases of poststroke depression with associated psychotic symptoms are rarely described in the literature, and, to our knowledge, no case of depression with psychotic symptoms in the presence of a focal lesion has yet been reported. METHOD: History included psychiatric, neurologic, and neuropsychological as well as EEG data and CT scan and magnetic resonance images. RESULTS AND CONCLUSIONS: Neurologic and psychiatric dimensions may be associated and difficult to disentangle, even when the patient presents the classic symptoms of a depressive disorder. This case underlines the importance of investigating possible neurologic signs or symptoms, even when the psychiatric presentation is prototypical of a determined mental disorder. This may be crucial for the patient's evolution.