Late-Onset Obsessive-Compulsive Disorder Secondary to Caudate Lacunar Infarct: A Case Report
Due to low prevalence of late onset Obsessive-Compulsive Disorder (OCD), it is more likely to have an organic etiology. In this article we present a 59-year-old man, referred for recently developed obsessive compulsive symptoms, with no prior history of OCD in the past. The symptoms were included ego-dystonic recurrent obsessional doubts, leaded him to compulsive checking several times a day and caused a remarkable distress and functional impairment. His neurological exam revealed no deficit. The most prominent finding in MRI was two large areas of focal gliosis and porencephaly located at head of right caudate. The size was 12 mm which is compatible with lacunar infarct. Frontal subcortical areas of signal change were noted. The symptoms were almost recovered only after 2 months treatment with sertraline 100 mg/daily and bupropione 150 mg/daily. It seems that there is a remarkable relationship between basal ganglia and frontal lesions, particularly infarction, with late-onset OCD.
American Psychiatric Association Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Archives of Iranian medicine. 2015 Feb;18(2):76-84. PubMed PMID: 25644794. Epub 2015/02/04. eng.
Rasmussen SA, Eisen JL. The epidemiology and clinical features of obsessive compulsive disorder. The Psychiatric clinics of North America. 1992 Dec;15(4):743-58. PubMed PMID: 1461792. Epub 1992/12/01. eng.
Swoboda KJ, Jenike MA. Frontal abnormalities in a patient with obsessive-compulsive disorder: the role of structural lesions in obsessive-compulsive behavior. Neurology. 1995 Dec;45(12):2130-4. PubMed PMID: 8848180. Epub 1995/12/01. eng.
Lopez-Rodriguez F, Gunay I, Glaser N. Obsessive compulsive disorder in a woman with left basal ganglia infarct: A case report. Behavioural neurology. 1997;10(2):101-3. PubMed PMID: 24486750. Epub 1997/01/01. eng.
Hofer H, Frigerio S, Frischknecht E, Gassmann D, Gutbrod K, Muri RM. Diagnosis and treatment of an obsessive-compulsive disorder following traumatic brain injury: a single case and review of the literature. Neurocase. 2013 Aug;19(4):390-400. PubMed PMID: 22784309. Epub 2012/07/13. eng.
Askari N, Moin M, Sanati M, Tajdini M, Hosseini SM, Modabbernia A, et al. Granisetron adjunct to fluvoxamine for moderate to severe obsessive-compulsive disorder: a randomized, double-blind, placebocontrolled trial. CNS drugs. 2012 Oct 1;26(10):883-92. PubMed PMID: 22873680. Epub 2012/08/10. eng.
Shalbafan M, Mohammadinejad P, Shariat SV, Alavi K, Zeinoddini A, Salehi M, et al. Celecoxib as an Adjuvant to Fluvoxamine in Moderate to Severe Obsessive-compulsive Disorder: A Double-blind, Placebo-controlled, Randomized Trial. Pharmacopsychiatry. 2015 Jul;48(4-5):136-40. PubMed PMID: 25959196. Epub 2015/05/12. eng.
Esalatmanesh S, Abrishami Z, Zeinoddini A, Rahiminejad F, Sadeghi M, Najarzadegan MR, et al. Minocycline combination therapy with fluvoxamine in moderate-to-severe obsessive-compulsive disorder: A placebo-controlled, double-blind, randomized trial. Psychiatry and clinical neurosciences. 2016 Nov;70(11):517-26. PubMed PMID: 27488081. Epub 2016/08/05. eng.
Arabzadeh S, Shahhossenie M, Mesgarpour B, Rezaei F, Shalbafan MR, Ghiasi Z, et al. L-carnosine as an adjuvant to fluvoxamine in treatment of obsessive compulsive disorder: A randomized double-blind study. Human psychopharmacology. 2017 Jul;32(4). PubMed PMID: 28485008. Epub 2017/05/10. eng.
Yaramis A, Herguner S, Kara B, Tatli B, Tuzun U, Ozmen M. Cerebral vasculitis and obsessivecompulsive disorder following varicella infection in childhood. The Turkish journal of pediatrics. 2009 JanFeb;51(1):72-5. PubMed PMID: 19378896. Epub 2009/04/22. eng.
Weiss AP, Jenike MA. Late-onset obsessive-compulsive disorder: a case series. The Journal of neuropsychiatry and clinical neurosciences. 2000 Spring;12(2):265-8. PubMed PMID: 11001607. Epub 2000/09/23. eng.
Carmin CN, Wiegartz PS, Yunus U, Gillock KL. Treatment of late-onset OCD following basal ganglia infarct. Depression and anxiety. 2002;15(2):87-90. PubMed PMID: 11892000. Epub 2002/03/14. eng.
Oh JH, Ahn BY, Jo MK, Yoon YJ, Park KH, Na DL, et al. Obsessive-compulsive behavior disappearing after left capsular genu infarction. Case reports in neurology. 2011 Jan 14;3(1):18-20. PubMed PMID:
Pubmed Central PMCID: PMC3037989. Epub 2011/02/18. eng.