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.