Serebral İskemi Sonrası Gelişen Obsessif Kompulsif Bozukluk Olgusu

Öz

Obsesif kompulsif bozukluk genellikle 2.3. on yılda ortaya çıkan tekrarlayıcı, istenmeyen, sıkıntı yaratıcı düşünce, imaj ya da dürtüler ve eşlik eden davranışlardır. Geç yaşta başlayan olgular nadirdir. 71 yaşındaki hasta sol tarafında güçsüzlük nedeniyle kliniğimize başvurdu. Nörolojik muayene ile sol hemiparezi, minimal disfazi ve anozognozi saptandı. Kranyal manyetik rezonans görüntülemede, sağda orta serebral arter kortikal dalı sulama alanında orta temporal girus posterior kısmı ile inferior parietal lobülde, lentikülostriat arter sulama alanında internal kapsül, sağ globus pallidus ve putamende infarkt alanı ve sağ internal karotid arterde (ICA) oklüzyon saptandı. 15 gün sonra idrar bulaşma korkusu, sürekli banyo yapma, el yıkama, uykusuzluk ve yoğun sıkıntı hissi yakınmaları gelişti. Davranışlarının saçma olduğunun bilincindeydi, fakat engelleyemiyordu. Nöropsikolojik testlerde basit dikkati hafif bozuktu. Vizuospasyal işlev ve kontrüksiyon yetileri de bozuk olarak değerlendirildi. Obsesif kompulsif bozukluk genelde erken yaşlarda başlamaktadır. Biz bu olgu ile serebrovasküler nedenlere sekonder gelişen ileri yaş olgulara dikkat çekmek istedik.

Anahtar Kelimeler

• Disasters, healthcare in disasters, undergraduate medical education

Obsessive Compulsive Disorder Case Following Cerebral Ischemia

Abstract

Obsessive compulsive disorder is characterised by recurrent, unwanted, distressing thoughts, images, impulses and associated behaviours which generally emerge in the 2nd

or 3rd

decades of life. Elderly onset cases are rare. A 71 year old patient was admitted to our hospital because of left-sided weakness. Neurological examination revealed left hemiparesis, mild dysphasia and anosognosia. Using cranial magnetic resonance, infarcts were found in the MCA territories, in the posterior portion of the middle temporal gyrus supplied by the cortical (inferior) branch and in the internal capsule, globus pallidus and putamen portions supplied by the lenticolos-triate branch. An occlusion was also present in the right internal carotid artery (ICA). Fifteen days after presentation he developed an abnormal fear of urine contamination. He showered and handwashed excessively and exhibited insomnia and anxiety. The patient knew that his behaviour was ridiculous but could not prevent it. Formal neuropsychological testing found his simple attention to be mildly impared. His visuospatial function and construction abilities were also impaired. Obsessive compulsive disorder is usually an early onset disease. However this report seeks to draw attention to late-onset cases such as this, which are due to a cerebrovascular disorder.

Keywords

• Disasters, healthcare in disasters, undergraduate medical education

Kaynakça

1. Koopowitz LF, Berk M. Response of Obsessive Compulsive Disor- der to Carbamazepine in Two Patients with Comorbid Epilepsy. Ann Clin Psychiatry 1997;9:171-3. [CrossRef]
2. Laplane D, Levasseur M, Pillon B, Dubois B, Baulac M, Mazoyer B, et al. Obsessive-compulsive and other behavioural changes with bilateral basal ganglia lesions a neuropsychological, mag- netic resonance imaging and positron tomography study. Brain 1989;112:699-725. [CrossRef]
3. Chacko RC, Corbin MA, Harper RG. Acquired Obsessive - Com- pulsive Disorder Associated With Basal Ganglia Lesions. J Neuro- psychiatry Clin Neurosci 2000;12:269-72.
4. George MS, Trimble MR, Ring HA, Sallee FR, Robertson MM. Obsessions in obsessive-compulsive disorder with and without Gilles de la Tourette’s syndrome Am J Psychiatry 1993;150:93-7. [CrossRef]
5. Topçuoğlu V, Aksoy A, Cömert B. Obsesif Kompulsif Bozuklukta Beyin Görüntüleme Çalışmaları Klinik Psikofarmakoloji Bülteni 2003;13:151-60.
6. Yaman A, Gürgen F. Obsesif Kompulsif Bozuklukta Elektroense- falografi Bulguları. Klinik Psikofarmakoloji Bülteni 2004;14:61-7.
7. Goodman WK, Price LH, Rasmussen SA, MazureC, Fleis- chmann RL, Hill CL, et al. The Yale Brown Obsessive Kompulsive scale, I: Development, use and reliability. Arch Gen Psychiatry 1989;46:1006-11.
8. Beşiroğlu L, Özer AÖ, Bal AC, Sağlam M. Kronik serebral iskemi sonrası obsesif-kompulsif belirtiler gösteren bir olgu. Klinik Psiko- farmokoloji Bülteni 2004;14:21-5.

9. Freeman Jm, Aron Am, Collard Je, Mackay Mc. The Emotional Correlates of Sydenham’s Chorea. Pediatrics 1965;35:42-9.
10. Borras L, Swine B, Constant EL, Huguelet P. Obsessive-compul- sive disorder following left middle cerebral artery infarct. Acta Neuropsychiatrica 2007;19:71-2. [CrossRef]
11. Kim WK, Lee DY. Obsessive-Compulsive Disorder Associated With a Left Orbitofrontal Infarct. J Neuropsychiatry Clin Neurosci 2002;14:88-9.
12. Mahendran R. Obsessive-compulsive disorder Following Left Middle Cerebral Artery Infarct. Singapore Med J 2000;41:498-9.
13. Thobois S, Jouanneau E, Bouvard M, Sindou M. Obsessive-com- pulsive disorder after unilateral caudate nucleus bleeding. Acta Neurochir (Wien) 2004;146-9. [CrossRef] 315
14. ; 28: 313-5 Bilge ve ark.
15. Obsessif Kompulsif Bozukluk Olgusu