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Obsessive compulsive disorder due to a cavernous malformation hemorrhage in the dominant caudate head

Brian S Katz1, Kelly D Flemming1

  • 1Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

Journal of Clinical Neuroscience : Official Journal of the Neurosurgical Society of Australasia
|August 16, 2014
PubMed

Insights

A brain lesion in the basal ganglia can cause obsessive-compulsive disorder (OCD). A woman developed OCD after her left caudate intracerebral cavernous malformation (ICM) bled, highlighting the link between brain structure and psychiatric conditions.

Area of Science:

  • Neuroscience
  • Neurology
  • Psychiatry

Background:

  • Basal ganglia structural lesions are implicated in the development of obsessive-compulsive disorder (OCD).
  • Intracerebral cavernous malformations (ICMs) are vascular malformations that can hemorrhage, presenting diverse neurological and psychiatric symptoms.

Observation:

  • A 31-year-old woman presented with new-onset obsessive-compulsive disorder (OCD).
  • The OCD developed subsequent to a hemorrhage in a previously asymptomatic left caudate intracerebral cavernous malformation (ICM).
  • Her neurological examination was unremarkable, but her psychiatric symptoms necessitated hospitalization and treatment.

Findings:

  • Hemorrhage of an intracerebral cavernous malformation (ICM) in the basal ganglia can precipitate obsessive-compulsive disorder (OCD).
  • The patient's OCD symptoms improved with pharmacotherapy and behavioral interventions.
  • The underlying pathophysiology may involve a frontal cortex deafferentation mechanism due to the basal ganglia lesion.

Implications:

  • Clinicians should consider repeat neuroimaging in patients with known ICMs experiencing sudden neurological or psychiatric changes to rule out hemorrhage.
  • This case underscores the critical relationship between focal brain lesions and the manifestation of psychiatric disorders like OCD.
  • Understanding the neuroanatomical basis of OCD can inform diagnostic and therapeutic strategies for related conditions.

Keywords:
CavernomaCavernous malformationObsessive compulsive disorderPsychiatric

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