Delayed-onset obsessive-compulsive symptoms after brain infarctions treated with paroxetine

A 68-year-old woman showed obsessive thought that she could not remember the names of people or items that she saw. She repeatedly asked her husband to recall names of unspecified people and checked the garbage to find the names of items. The patient had a history of cerebral infarctions in the left middle cerebral artery regions 2 and 15 months before the emergence of her symptoms. A magnetic resonance imaging examination showed signs of an old infarction in the left basal ganglia and ischemic signs in the right temporal lobe. Her obsessive-compulsive symptoms relating to words were successfully treated with a serotonin selective reuptake inhibitor, paroxetine, at the dose of 40 mg/d. Her scores on the Yale-Brown Obsessive Compulsive Scale reduced from 31 to 8 points after this treatment. This case may suggest therapeutic modulation of language-related cortical activity elicited by paroxetine.