A compulsive collecting behavior following an A-com aneurysmal rupture.

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Focal brain injuries, particularly those affecting the orbitofrontal cortex and basal ganglia, can lead to complex behavioral changes.
• Hoarding disorder is a distinct diagnostic entity, but its association with specific focal brain lesions is infrequently documented.

Observation:

• A 46-year-old male patient presented with new-onset pathologic collecting behavior after experiencing a subarachnoid hemorrhage due to an anterior communicating artery aneurysm rupture.
• The brain injury specifically involved the left orbitofrontal cortex and the head of the caudate nucleus.
• The patient's hoarding behavior was highly specific, focusing exclusively on collecting toy bullets.

Findings:

• The observed collecting behavior was characterized as an ego-syntonic compulsion, suggesting a lack of insight or distress regarding the behavior.
• Pharmacological interventions, including selective serotonin reuptake inhibitors like sertraline and fluoxetine, did not yield any improvement in the hoarding symptoms.
• The case highlights a rare instance of hoarding behavior directly linked to a specific focal brain injury.

Implications:

• This case underscores the critical role of the orbitofrontal cortex and caudate nucleus in regulating impulse control and complex behaviors, including hoarding.
• Understanding the neurobiological underpinnings of hoarding behavior in the context of focal brain injury may inform future treatment strategies.
• Further research is warranted to explore the specific neural pathways involved in focal brain injury-induced hoarding and to develop targeted therapeutic interventions.