Obsessive-Compulsive Disorder Following Cerebrovascular Accident: A Case Report and Literature Review

Akaho, Rie; Deguchi, Ichiro; Kigawa, Hiroshi; Nishimura, Kazuhiko

doi:10.1016/j.jstrokecerebrovasdis.2018.12.034

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…In contrast to the previous studies describing correlation between cerebrovascular insult and OCD (cases of OCD following arterial stroke), our case is the first 28 Relapse of obsessive-compulsive disorder after cerebral venous sinus thrombosis: a case report K case report one describing a severe OCD relapse after suffering from sinus venous thrombosis [8]. CVT results in 0.5-1% of all strokes in adults with an estimated incidence of 3-4 cases per million people, while about 75% of all affected patients are women [6,7].…”

Section: Discussioncontrasting

confidence: 67%

“…A common MRI diagnostic finding in CVST is an abnormal signal intensity within the venous structure, which is an indication for altered flow and thrombus formation. Cases of OCD following CVA have not been frequently reported, and interestingly, it has been shown that initiation of OCD symptoms may vary from 1 month to 2 years post CVA [8]. In the present case, the patient was gradually re-developing OCD post CVST, while the maximum intensity of the symptoms was reached approximately one year later.…”

Section: Discussionmentioning

confidence: 42%

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Relapse of obsessive–compulsive disorder after cerebral venous sinus thrombosis: a case report

2019

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Obsessive-compulsive disorder (OCD) is characterized by repetitive, persistent and unwanted thoughts and ritualistic, repetitive behaviors. The pathophysiology of OCD involves many distinct cortical and subcortical regions and it has been reported that OCD may occur as a consequence of traumatic brain injury, infections and tumors as well as cerebrovascular insult such as cerebral venous sinus thrombosis (CVST). We here describe the case of a 36-year-old woman who developed OCD at the age of 13 with almost complete remission of the symptoms after a 1 year-long treatment. Interestingly, after suffering CVST at the superior sagittal sinus at the age of 33, she experienced a relapse of OCD. The patient was successfully treated with Sertraline and Clomipramine. Previous studies revealed cases of OCD following different cerebrovascular accidents, i.e. predominantly arterial stroke. However, the present case is the first to describe OCD after venous thrombosis. Based on our clinical experience, the most effective treatment of OCD after CVST represents the combination of the selective serotonin reuptake inhibitor Sertraline and the tricyclic antidepressant Clomipramine. ZusammenfassungDie Zwangsstörung (OCD) ist gekennzeichnet durch sich wiederholende, anhaltende und unerwünschte Gedanken sowie rituelle, sich wiederholende Verhaltensweisen. Die Pathophysiologie der OCD umfasst viele distinkte kortikale und subkortikale Regionen. Berichtet wurde, dass eine OCD als Folge von Infektionen, Tumoren, traumatischen Hirnläsionen und zerebrovaskulären Insulten, beispielweise einer zerebralen Sinusvenenthrombose (CVST), auftreten kann. Wir stellen eine 36-jährige Frau vor, die im Alter von 13 Jahren eine OCD entwickelte, wobei nach einer einjährigen Behandlung eine fast vollständige Remission der Symptome erzielt wurde. Interessanterweise erlitt sie ein Jahr nach einer CVST der V. sagittalis superior im Alter von 33 Jahren ein Rezidiv der OCD. Sie wurde mit einer Kombination aus Sertralin und Clomipramin erfolgreich behandelt. Frühere Studien zeigten Fälle von OCD nach verschiedenen zerebrovaskulären Störungen, vorwiegend nach arteriellem Schlaganfall. Die vorliegende Publikation ist jedoch die erste, in welcher eine OCD nach einer venösen Thrombose beschrieben wird. Nach unserer klinischen Erfahrung besteht die wirksamste Behandlung einer OCD nach CVST in einer Kombination des selektiven Serotoninwiederaufnahmehemmers Sertralin mit dem trizyklischen Antidepressivum Clomipramin. Schlüsselwörter OCD · Zerebraler Insult · Sertralin · Clomipramin · Kombinationstherapie

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Section: Discussioncontrasting

confidence: 67%

Section: Discussionmentioning

confidence: 42%

Relapse of obsessive–compulsive disorder after cerebral venous sinus thrombosis: a case report

2019

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“…More recent work has reported an association between basal ganglia infarctions and the development of obsessive-compulsive disorder (OCD). [7][8][9] Akaho et al 9 conducted a literature review which demonstrated that out of 21 cases of OCD following stroke, the most frequent site of lesion was the basal ganglia, with 12 cases.…”

Section: Discussionmentioning

confidence: 99%

“…Many adult stroke patients suffer from generalized anxiety, major depressive disorder, phobias, and/or obsessive-compulsive disorder following a stroke in which the basal ganglia was involved. [1][2][3][4][5][6][7][8][9] However, there are few studies describing mood disorders after pediatric basal ganglia stroke, and little data on how mental health issues in children after stroke affect the whole family, or how long recovery takes. This report presents 2 children with mental health issues after basal ganglia stroke and reviews the literature on the effects of basal ganglia stroke on mental health in adults and children.…”

Section: Introductionmentioning

confidence: 99%

The Impact of Pediatric Basal Ganglia Stroke on Mental Health in Children: Report of 2 Cases

Badar

Radhakrishnan

Golomb

2020

Child Neurology Open

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Background: The impact of basal ganglia stroke on mental health is better described in adults than in children. We report 2 children with significant mental health issues after basal ganglia stroke. Case Reports: Patient 1, an 8-year-old boy, had mild anxiety before his left basal ganglia stroke. Post-stroke, he developed severe anxiety, obsessions, depression, and attention deficit hyperactivity disorder, in addition to a right hemiplegia and some mild chorea. He gradually improved over 3 years with psychiatric care and medication but continued to have residual symptoms. Patient 2, a 10-year-old boy, had no history of mental health issues before his right basal ganglia stroke. Post-stroke, he developed significant anxiety and mild depression, along with a left hemiplegia. He improved over 9 months and returned to his mental health baseline. Conclusions: Mental health issues after basal ganglia stroke in children can be significant, and recovery can take months to years.

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“…OCD-like behaviours have been described in association with abnormalities in the basal ganglia as well as in the orbitofrontal cortex in a wide range of neurological disorders (Laplane et al, 1989;Etcharry-Bouyx et al, 2000;Cummings, 1995), suggesting the involvement of cortico-striato-thalamo-cortical circuits implicated in cognitive, emotional-affective, self-activation and motor aspects of behaviour (Cummings, 1995;Levy and Dubois, 2006). In cerebrovascular accidents, the semiology arises mostly from lesions to the basal gangliathough frontal, parietal and temporal regions may also be involved (Akaho et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

Compulsions without obsession following stroke

et al. 2021

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Obsessive-Compulsive Disorder Following Cerebrovascular Accident: A Case Report and Literature Review

Cited by 7 publications

References 21 publications

Relapse of obsessive–compulsive disorder after cerebral venous sinus thrombosis: a case report

Relapse of obsessive–compulsive disorder after cerebral venous sinus thrombosis: a case report

The Impact of Pediatric Basal Ganglia Stroke on Mental Health in Children: Report of 2 Cases

Compulsions without obsession following stroke

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