Evidence for striatal modulation in the presence of fixed cortical injury in obsessive-compulsive disorder (OCD)

A patient with obsessive-compulsive disorder (OCD) onset resulting from a t raumatic head injury underwent longitudinal brain imaging evaluation. Struc tural and functional brain imaging studies were repeatedly performed before and after treatment. Computerized tomography (CT) demonstrated bilateral p refrontal contusions immediately following the trauma and prior to the onse t of OCD. Magnetic resonance imaging (MRI) demonstrated bilateral cortical abnormalities in the prefrontal and anterior-temporal regions a few months following the onset of OCD. Almost concurrently, single photon emission com puterised tomography (SPECT) demonstrated bilateral perfusion deficits in f ronto-temporal regions, and asymmetric increased perfusion in the anterior striatum. Six months later, after clinical improvement, a second SPECT stud y demonstrated improvement of brain perfusion, mostly in the striatum. The reflection of these results on a possible model of brain pathogenesis in OC D, and the role of brain imaging in neuropsychiatric evaluation, are demons trated. (C) 1999 Elsevier Science B.V./ECNP. All rights reserved.