But all that changed - when she suffered a stroke. This is according to a brief case report from Drs. Diamond and Ondo of Texas:[she] had a long history of constant intrusive and obsessive thoughts that interrupted her daily activities and sleep. She had constant unfounded fears that something bad would happen to her family and had persistent violent thoughts of using knives to harm family members. She would check the door locks up to 15 times a day. In addition to her OCD symptoms, she had ... inattention, poor concentration, and difficulty sitting still.She had never been treated for the OCD, despite how it interfered with her life, because she feared losing her job as a teacher if she sought psychiatric help. But then...
Nine months before approaching us, she developed the acute onset of paresthesia [weird sensations] and weakness in the left upper extremity and face, associated with slurred speech. Initially, she was unable to lift her arm against gravity.These are classic signs of a stroke, but it was a very mild one, because the symptoms only lasted a few minutes and were pretty much gone even before she arrived at the emergency room. She made a full recovery. More than a full recovery in fact:
Within weeks of her stroke, she realized that her obsessive and intrusive thoughts, fears, rituals, and impulsive behavior had completely resolved. In addition, there was some improvement in her temperament. There was no improvement in attention or concentration. Owing to her improvement in neuropsychiatric symptoms, she strongly felt that her stroke was beneficial. These benefits have persisted for 24 months.Most medical case reports concern patients who died, or got really sick, in a particularly interesting fashion, but this one has a happy ending. Strokes can be devastating, of course, although people also make full recoveries - it all depends on the severity of the stroke, and whether they get prompt treatment.
There have been a few other cases of brain damage which brought unexpectedly beneficial effects. In Vietnam veterans, for example, people with damage to the vmPFC due to combat trauma seemed to be protected from depression.
Whether the stroke really cured her, or whether it was some kind of psychological "placebo" effect, we'll never know. It's hard to see why a stroke would have a placebo effect, but on the other hand, an MRI scan revealed that the stroke occured in an area of the brain - the right frontoparietal cortex - which is fairly low down on the list of "OCD-ish" areas.
The authors make some vague comments about "modulation of the cortical–subcortical circuits" but this is really the neuroscientific equivalent of saying "We guess it did something", because the entire brain is made of cortical-subcortical circuits, given that the cortex is at the top and everything else is, by definition, the sub-cortex. It's quite possible. But we really can't tell.
Diamond A, & Ondo WG (2011). Resolution of Severe Obsessive-Compulsive Disorder After a Small Unilateral Nondominant Frontoparietal Infarct. The International journal of neuroscience PMID: 21426244
7 comments:
"We found a distribute network of frontal, parietal and temporal areas".
So she couldn't attend or concentrate, but she didn't have intrusive thoughts anymore. Such a deal!!!!
In Japan, amelioration from OCD after hemorrhage in brain has been reported like Diamond & Ondo(2011), although Japan's case is different from Diamond & Ondo(2011) in some ways. The Japan's case(in japanese): http://www.jstage.jst.go.jp/article/fpj/125/2/125_83/_article/-char/ja/
Anonymous #1: Heh. Or as it's otherwise called "The Brain".
#2: She had inattention before the stroke; the stroke didn't cure that but it didn't make it any worse.
I thought about Lobotomy when i read about that one.
C'mon, wouldn't it be great if one could replicate the results?
Of course we can be glad nobody tries that with an ice pick in his office.
Is it just me, or does this MRI image look more like a low quality CT scan than an anatomical MRI image?
More importantly, this result seems highly unlikely. Which seems more plausible, that a very mild stroke produced a small parietal lesion that completely abolished the woman's severe obsessions, or that she simply misremembered or misrepresented her former symptoms?
Also, there is no way to know whether or not this stroke worsened the woman's use of attentional resources. In either case, the fact that this woman's entire medical history is retrospective makes for a mighty confound.
The fact that there are any cases of severe OCD resolving by any means is very hopeful and publication worthy, regardless of the effect on attention. It suggests that there is some very subtle "switch" either psychological or neurological that, if switched in just the right place in just the right way, probably simply by killing a tiny percentage of brain cells, can end the syndrome.
Simply looking for a neural mechanism that a TIA or minor stroke could disrupt and those it could not could discriminate among various theories of what is going on in OCD.
"Which seems more plausible, that a very mild stroke produced a small parietal lesion that completely abolished the woman's severe obsessions, or that she simply misremembered or misrepresented her former symptoms?"
Given the long duration and extreme nature of the symptoms and family history of problems, misremembering or misrepresenting former symptoms seems highly unlikely. For example, SSRI effectiveness suggests that the serotonin system might be implicated in some way, but a brain-wide serotonin problem wouldn't be alleviated by this kind of stroke, so one would favor more localized theories.
Perhaps, for example, the brain still is signalling for OCD behavior but some final link that connects those signals into a call to act or think about them was disconnected even though it is not itself broken or atypical.
It would be very interesting, and perhaps Diamond & Ondo discuss, what other symtoms manifested besides the disappearance of OCD. Very intensive examination of related and subtle "side effects" of this stroke that the patient wouldn't think to associate with it could be highly informative.
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