A case of othello's syndrome: A neuropsychiatric complication of cerebrovascular disease in Uyo, Southern Nigeria

Abstract

Neuropsychiatric conditions are rare complications of cerebrovascular diseases. We present a case of Othello’s syndrome (delusional jealousy) as a complication of right temporal infarct. This to the best of our knowledge is the first report in Nigeria. The patient is a 62 year old man with a diagnosis of hypertension for 7 years who had an extensive right temporo-occipital infarct. He had been happily married for about 30 years with no issues of infidelity all through the marriage. Four days after the infarct, he started accusing the wife of infidelity and making attempts to kill him. He insisted that he sees her lover jumping into their bedroom through the window which has iron bars. He also claims that he smells a peppery sensation or formalin released to poison him. The accusations worsened to accusing the wife of bringing in seven lovers into the bedroom. He informed all his relatives, neighbours and church members of the wife’s perceived infidelity and supposed plans to kill him. He also filed a police report accusing his wife of plans to murder him. On one occasion, he took a kitchen knife and attempted to stab the wife to death. He was given antipsychotic medications and referred to the psychiatrist. He however refused to take the medications and declined to see the psychiatrist. Further management included collaboration with the police who ensured that he came for psychiatric consultations. Since he commenced mental health care, he has been stable. Neuropsychiatric conditions are rare complications of cerebrovascular diseases.