Trouble obsessionnel compulsif secondaire. À propos d'un cas

Abstract

The discovery by morphological cerebral imagery methods of abnormalities or lesions in patients with psychiatric diseases has led to the concept of secondary troubles. This concept is discussed from the case of a patient with a typical obsessive–compulsive disorder (OCD) in whom MRI found a left temporal arachnoid cyst, which was probably incidental, and a bilateral lesion of the globi pallidi which was the possible consequence of an old carbon monoxide intoxication. It is suggested that the distinction: primary versus secondary troubles is going to fade with the occurrence of more efficient methods of cerebral imagery. This new case of secondary OCD confirms the role of a disjunction or a dysfunction (in primary forms) of a cortico-basal circuit as a common pathophysiologic mechanism in OCD. Neurosurgical functional manipulation of this circuit represents a new hope for the therapeutics.