Case Report: Obsessive compulsive disorder in posterior cerebellar infarction - illustrating clinical and functional connectivity modulation using MRI-informed transcranial magnetic stimulation

Wellcome Open Research

article

Urvakhsh Meherwan Mehta¹  Darshan Shadakshari¹  Pulaparambil Vani¹  Shalini S Naik¹  V Kiran Raj²  Reddy Rani Vangimalla⁴  YC Janardhan Reddy¹  Jaya Sreevalsan-Nair⁴  Rose Dawn Bharath² 

[1] Department of Psychiatry, National Institute of Mental Health and Neurosciences;Department of Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences;Cognitive Neuroscience Centre, National Institute of Mental Health and Neurosciences;Graphics Visualization Computing Lab and E-Health Research Centre, International Institute of Information and Technology

关键词: Obsessive Compulsive Disorder;    Cerebellar cognitive affective syndrome;    Neuromodulation;    Functional brain connectivity;    Cerebellar infarct;    Theta burst stimulation;   

DOI  :  10.12688/wellcomeopenres.16183.2

学科分类：内科医学

来源: Wellcome

【 摘 要 】

Objectives: We describe atypical and resistant neuropsychiatric clinical manifestations in a young male with posterior cerebellar gliosis. We also attempt to test the mediating role of the cerebellum in the clinical presentation by manipulating the frontal-cerebellar network using MRI-informed transcranial magnetic stimulation (TMS).Methods: A case report of a young adult male describing obsessive-compulsive symptoms, probably secondary to an infarct in the cerebellar right crus II, combined with an examination of behavioral and functional connectivity changes following TMS treatment.Results: Obsessions, compulsions, and pathological slowing were observed in the background of a posterior cerebellar infarct, along with impairments in vigilance, working memory, verbal fluency, visuospatial ability, and executive functions, in the absence of any motor coordination difficulties. These symptoms did not respond to escitalopram. MRI-informed intermittent theta-burst stimulation delivered to the pre-supplementary motor area identified based on its connectivity with the cerebellar lesion in the crus II resulted in partial improvement of symptoms with enhanced within and between-network modularity of the cerebellar network connectivity.Conclusion: We illustrate a case of OCD possibly secondary to a posterior cerebellar infarct, supporting the role of the cerebellum in the pathophysiology of OCD. Functional connectivity informed non-invasive neuromodulation demonstrated partial treatment response. A seriation technique showed extended connectivity of the cerebellar lesion regions following the neuromodulatory treatment.

【 授权许可】

CC BY