Can Cerebral Venous Sinus Thrombosis Trigger a Relapse of Obsessive-Compulsive Disorder?

What you need to know

• Obsessive-Compulsive Disorder (OCD) can relapse or worsen after cerebrovascular events, including cerebral venous sinus thrombosis (CVST).
• The onset of OCD symptoms following a cerebrovascular accident may vary from 1 month to 2 years.
• A combination treatment of Sertraline (an SSRI) and Clomipramine (a tricyclic antidepressant), along with cognitive behavioral therapy, was effective in treating OCD relapse after CVST.

Understanding Obsessive-Compulsive Disorder (OCD)

Obsessive-Compulsive Disorder, commonly known as OCD, is a mental health condition that affects approximately 2-3% of the global population. It’s characterized by two main components:

1. Obsessions: These are recurring, unwanted thoughts that cause distress or anxiety.
2. Compulsions: These are repetitive behaviors or mental acts that a person feels driven to perform in response to the obsessions.

For example, someone with OCD might have an obsessive fear of germs (the obsession) and feel compelled to wash their hands excessively (the compulsion) to alleviate this fear.

OCD can significantly impact a person’s daily life, consuming hours of their time and interfering with work, relationships, and overall quality of life. The good news is that OCD is treatable, with many patients responding well to a combination of medication and therapy.

The Unexpected Link: Cerebral Venous Sinus Thrombosis and OCD

While it’s well-known that OCD can develop on its own, sometimes it can be triggered or worsened by other medical conditions. This case study presents an intriguing situation where a patient experienced a relapse of OCD following a cerebral venous sinus thrombosis (CVST).

CVST is a rare type of stroke that occurs when a blood clot forms in the brain’s venous sinuses, which are responsible for draining blood from the brain. It’s less common than other types of strokes and can be challenging to diagnose due to its varied symptoms.

In this case, a 36-year-old woman who had previously experienced OCD in her teens suffered from CVST at age 33. Interestingly, about a year after the CVST, she began experiencing a severe relapse of her OCD symptoms.

The Patient’s Journey

Let’s break down the patient’s history to better understand the progression of events:

1. At age 13: The patient first developed OCD symptoms, primarily emetophobia (fear of vomiting) and obsession with cleanliness.

2. After initial treatment: Her symptoms went into almost complete remission following a year of treatment.

3. At age 33: The patient suffered from CVST, experiencing sudden weakness in her left side and severe headache.

4. One year after CVST: The patient gradually began redeveloping OCD symptoms, which escalated to the point where she could no longer work.

5. At age 34: The patient’s OCD symptoms had become severe, including extensive hand washing, showering and dressing rituals, and compulsive checking of doors, locks, and stoves. These rituals consumed more than 8 hours of her day.

Measuring OCD Severity

To understand the severity of the patient’s OCD relapse, it’s important to know how OCD is measured. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a widely used tool for assessing OCD severity. It has a maximum score of 40 points, with 20 points each for obsessions and compulsions. A score higher than 24 is considered severe OCD.

When the patient was assessed at the clinic, her Y-BOCS score was 36 (20 for obsessions and 16 for compulsions), indicating very severe OCD.

The Treatment Approach

The treatment plan for this patient involved a combination of medication and therapy:

1. Medication: The patient was prescribed a combination of two drugs:

   • Sertraline: This is a selective serotonin reuptake inhibitor (SSRI), a type of antidepressant commonly used to treat OCD.
   • Clomipramine: This is a tricyclic antidepressant, another class of drugs effective in treating OCD.

2. Therapy: The patient also received cognitive behavioral therapy (CBT), a type of psychotherapy that’s particularly effective for OCD.

This combination treatment is in line with current recommendations for treating severe OCD, which suggest using SSRIs at high doses or augmenting them with other medications.

Treatment Outcomes

The results of this treatment approach were promising:

• After 8 weeks: The patient began to show an initial reduction in OCD symptoms.
• After 1 year: The patient’s Y-BOCS score had decreased to 16 (6 for obsessions and 10 for compulsions), indicating a significant improvement.

While complete remission wasn’t achieved, this represents a substantial reduction in symptoms and improvement in the patient’s quality of life.

Implications for Understanding OCD and Stroke

This case study provides valuable insights into the relationship between cerebrovascular events and OCD:

1. OCD can occur or relapse following various types of stroke, including less common types like CVST.

2. The onset of OCD symptoms after a cerebrovascular accident can vary widely, from 1 month to 2 years post-event.

3. Combination treatment involving high-dose SSRIs, augmentation with other medications, and CBT can be effective in treating OCD that occurs after cerebrovascular events.

The Importance of Awareness

This case highlights the importance of monitoring mental health following any type of stroke, including CVST. Healthcare providers, particularly neurologists and psychiatrists, should be aware that OCD symptoms can develop or worsen in the months or years following a cerebrovascular event.

For patients and their families, it’s crucial to be aware of potential changes in behavior or thought patterns following a stroke and to seek help if OCD-like symptoms develop.

Conclusions

• Cerebral venous sinus thrombosis can potentially trigger a relapse or worsening of OCD symptoms.
• The onset of OCD symptoms following a cerebrovascular event can be delayed, occurring up to two years post-event.
• A combination treatment approach involving medication and cognitive behavioral therapy can be effective in managing OCD symptoms that develop after cerebrovascular events.
• Ongoing monitoring of mental health following any type of stroke is crucial for early detection and treatment of conditions like OCD.