The stroke can have tragic, but also amazing consequences. The review Neurocase Recently reported the case of rare neurological disorders: Othello syndrome. In the affected woman, this resulted in a delirium of jealousy. She was then convinced that her husband was unfaithful to her, and more than once, despite the lack of objective evidence.
Convinced that he cheated on her with his sister and then with a friend
This woman, hitherto balanced and in happy couple for over thirty years, has been the victim of a bilateral thalamic stroke, linked to the obstruction of the artery of Percheron, a rare configuration. Brain lesions, mainly located in the right thalamus, have triggered cognitive and emotional disorders, including hallucinations, confusion, and disorientation. But above all, a few days after leaving the hospital, the patient began to accuse those around her, first her sister, then the daughter of a friend, to maintain a affair with her husband.
Little by little, jealousy has intensified until becoming central in her daily life. She spied on her husband, searched her phone, woke him in the middle of the night to question her. The situation has changed in violence: twice, she assaulted it with a stabbing weapon. Although she denied these acts thereafter, her delusions of jealousy continued with the same intensity.
A passionate delirium, the fruit of a neurological involvement
Doctors then diagnosed Othello Post-AVC syndrome, a rare type of psychosis secondary to brain injury. According to Dr. Gérald Kierzek, emergency doctor,
“”Othello’s syndrome manifests itself by a passionate delirium centered on supposed infidelity of the partner. It is a rare, but well documented disorder, which can occur as a result of neurological involvement.“”
This syndrome is part of the classification of personality and behavior disorders due to a stroke, he recalls.
“In general, a stroke can deeply affect personality and mood. It depends on the location of the lesion, its extent, the age of the patient and other factors.”
When the brain deforms reality
The thalamus, a brain structure affected in this case, is a crucial relay center between the emotional (like the limbic system) and cognitive (like the prefrontal cortex). An attack of this area, especially on the right, can disrupt the circuits of emotional regulation, alter the judgment, accentuate distrust and give birth to delusional thoughts. What happened with this patient victim of her own delusions.
“This type of psychiatric picture is misleading, because it can resemble a classic psychosis, but it actually has an organic, neurological origin. This is why it is essential to search for an organic cause in front of any disorder of the brutal appearance personality “, insists Dr. Kierzek. It recommends a complete neurological assessment, including scanner or brain and blood test, before any psychiatric conclusion.
In the case of this patient, examinations made it possible to dismiss other causes (dementia, drug toxicity, etc.). His condition was covered by antipsychotic treatment. After a first phase of improvement followed by a relapse, a change in molecule allowed sustainable stabilization. Over the months, her symptoms have disappeared and she recognized that her suspicions were unfounded.
Rare cases but to take seriously
Othello post-AVC syndrome remains rare, but it is one of the multiple faces that a brain injury can take. Psychotic symptoms can occur after a stroke, although the most frequent manifestations are depression or anxiety. Among post-AVC psychoses, delusional jealousy is one of the most frequently described motifs in the literature.
Beyond mental suffering, these disorders can represent a danger for those around them, as shown in this case.
Dr. Kierzek alerts on this point: “Changes in behavior after a stroke can be brutal and difficult to live for loved ones. Disinhibition, judgment disturbances, access to anger or paranoia can occur, sometimes without immediately making the link with brain damage.“”
Specialized follow -up with a neurologist and a psychiatrist is therefore essential. Finally, this type of case highlights the importance of detailed clinical studies, even isolated, to better understand the links between brain and behavior. They also recall that personality and emotions, often considered immutable, can be deeply upset by a simple clot in an artery.