Hoarding behavior associated with focal brain injury is rarely reported. Th
e authors report a 46-year-old man with pathologic collecting behavior afte
r a left orbitofrontal and caudate injury from an aneurysmal rupture of ant
erior communicating artery. His hoarding, an impulse control disorder or an
ego-syntonic compulsion, was restricted to one specific item (toy bullet).
Treatments with sertraline or fluoxetine were not effective for the hoardi
ng.