“SOMETHING BAD CAN HAPPEN”. THE CASE OF A 73 YEAR OLD MAN WITH OBSESSIVE COMPULSIVE DISORDER DUE TO RIGHT HEMISPHERIC INFARCTS

Abstract

Introduction Obsessive Compulsive Disorder (OCD) following Cerebrovascular Accidents (CVA) is rare but people with CVA are at a higher risk of having OCD than the general population. Here, we present the case of a man who developed OCD after finding lacunar infarcts of the right hemisphere.This is one of the few case reports as this topic is in the early stages of research. Methods Patient was assessed and followed in outpatient psychiatry clinic.The case was reviewed and compared with relevant literature. Results This is a case report of a 73 year old man with history of Type 2 Diabetes and hypertension, no reported psychiatric history or developmental issues, who was referred to our psychiatry clinic after reporting a two year history of repeated daily checks and rituals in his home which were becoming more distressing and disruptive to his daily activities.On interview the patient reported frequently checking outlets, faucets, lights, and even his own clothes for dirt, and excessive hand washing. Patient reported that these checks took up to four hours per day causing him to frequently miss prior engagements and even awakens him at night. During the interview he cleaned the chair before sitting and asked the interviewer to check for stains on his coat. He described related nonspecific obsessive and intrusive thoughts that “something bad can happen” and was worried about contamination. He expressed relief of tension when performing these compulsions. Neurological examination was unremarkable and MMSE 28. CT scan of the brain without contrast, done two years prior to presentation, showed that the patient suffered from a lacunar infarct in the anterior limb of the internal capsule, extending into the putamen (basal ganglia). A diagnosis of Obsessive-Compulsive and Related Disorder due to Cerebral Infarction was made and he was started on an ongoing trial of Sertraline. Conclusions This case shows the rare development of OCD post cerebrovascular infarct in the right basal ganglia. Organic causes for late onset OCD should be considered when symptoms occur above age 50. Literature review suggests orbitofrontal cortex, basal ganglia and anterior cingulate cortex are most consistently implicated but not definitive. Review of cases shows that SSRI appear to be most effective in treating this rare disorder. Further studies on this topic is needed to provide additional details of the clinical features and structural/functional imaging finding. This research was funded by: NA