OBSESSIVE-COMPULSIVE DISORDER ASSOCIATED WITH BRAIN-LESIONS - CLINICAL PHENOMENOLOGY, COGNITIVE FUNCTION, AND ANATOMIC CORRELATES

We studied the behavioral, cognitive, and neuroimaging characteristics of obsessive-compulsive disorder (OCD) in 13 patients with focal brai n lesions (acquired OCD) and compared their clinical features and the severity of obsessive and compulsive (OC) symptoms with patients with idiopathic OCD. Both OCD groups were further compared with matched nor mal controls on a series of neuropsychological tests. Patients with ac quired OCD had a negative familial history and later age at onset of O CD symptoms than patients with idiopathic OCD. The two OCD groups show ed relatively similar clinical phenomenology, severity of OC symptoms, and profile of neuropsychological deficits. Compared with normal cont rol subjects, both OCD groups showed cognitive deficits affecting atte ntion, intellectual function, memory, word retrieval, and motor and ex ecutive functions. Eight of the 13 patients with acquired OCD had abno rmal neurologic examinations, whereas only 3 of the 13 patients with i diopathic OCD had abnormal neurologic examinations. Neuroimaging in th e acquired OCD group disclosed a variety of lesions involving exclusiv ely the cerebral cortex (frontal, temporal, or cingulate regions), the basal ganglia, or both. These results suggest that acquired and idiop athic OCDs may share a common pathophysiologic mechanism, and that str uctural damage to specific frontal-limbic-subcortical circuits plays a n important role in the pathogenesis of acquired OCD.