Sometimes damaging your brain makes you better, not worse.
A 33 year old woman who had been sexually abused as a child had obsessive compulsive disorder (her YBOCS score, for those keeping count, was 25) in which she was convinced her genitals were dirty and needed to clean them; a need for symmetry and order that led her to check and recheck and recount and reread and rewrite; and a need to hoard and save. Medications couldn’t touch her OCD, though they helped her mood: the following combination did nothing to reduce her compulsions: an anti-depressant (paroxetine 20mg) + anti-psychotic (olanzapine 20mg) + mood stabilizer (valproate 1500mg) + anti-anxiety (clonazepam 2mg).
Hopeless, she overdosed on all her meds with alcohol, wasn’t found for 3 hours, and spent 3 days in a coma in the ICU. When she awoke, she appeared to have had a stroke, with difficulty with handwriting, some difficulty pronouncing words, with declines in memory, felt like nothing mattered,
In addition, her OCD was essentially cured (YBOCS fell to 9).
A self-induced stroke cured the patient of the unshakeable sense of making mistakes
What this figure shows is what the stroke killed – and preserved – in her brain. What it killed was the ‘association area’ of the caudate – not the so-called limbic portion. Her dystonia was most likely a reflection of her putamen lesion.
