Compulsions without obsession following stroke.

Area of Science:

• Neuroscience
• Neurology
• Psychiatry

Background:

• Obsessive-compulsive disorder (OCD) involves intrusive thoughts and repetitive behaviors, with OCD-like symptoms seen in various neurological disorders.
• Cerebrovascular accidents, particularly those affecting basal ganglia and cortical regions, can manifest OCD-like behaviors.
• Recent research re-examines OCD mechanisms, focusing on the interplay between anxiety, obsessions, and compulsions, with differing models emphasizing obsessions as triggers versus compulsions as core to maladaptive habit learning.

Purpose of the Study:

• To present neurological evidence of pure compulsions without obsessions in a patient post-stroke.
• To provide comprehensive neuropsychological findings detailing executive and emotional domain alterations.
• To analyze MRI data for network connectivity changes resulting from the subcortical stroke.

Main Methods:

• Neurological examination and assessment of a stroke patient.
• Comprehensive neuropsychological testing focusing on executive functions and emotional domains.
• Magnetic Resonance Imaging (MRI) analysis to evaluate brain structure and functional connectivity.

Main Results:

• Neurological evidence of pure compulsions, without obsessions, was identified in a patient with a left subcortical stroke.
• Neuropsychological findings revealed specific alterations in executive and emotional processing.
• MRI analysis indicated a significant decrease in connectivity, suggesting widespread network alterations due to the stroke.

Conclusions:

• This case offers direct evidence linking brain structure and function in obsessive-compulsive disorder (OCD).
• The findings underscore the pivotal role of compulsive behaviors in the pathology of OCD.
• The study highlights the impact of subcortical lesions and network alterations on OCD symptomatology.