A presumptive association between obsessive compulsions and asymmetric temporal lobe atrophy: a case report

Abstract

Background: The relatively isolated atrophy of the temporal lobes leads to a clinical radiological pattern, referred to as the temporal variant of frontotemporal dementia. While semantic dementia and behavioral variant frontotemporal dementia are classically related to this syndrome, the logopenic variant of primary progressive aphasia has been less commonly reported. This case report aims to give a pictorial description of a case in which a patient with asymmetric temporal lobe atrophy presented with the logopenic variant of primary progressive aphasia and complex rituals of cleanliness.

Case presentation: We report on the case of a 68-year-old, right-handed White woman with complex rituals and progressive speech impairment. The obsessive-compulsive rituals represented an exacerbation of lifelong preoccupations with cleanliness and orderliness that were praised by her relatives. Neuropsychological assessment revealed a striking impairment of language and memory, with relative sparing of tool-use praxis and visuospatial skills. Magnetic resonance imaging and ¹⁸fluorodeoxyglucose-positron emission tomography scans showed bilateral asymmetrical temporal lobe atrophy and hypometabolism. A year later, she was still able to entertain conversation for a short while, but her vocabulary and fluency had further declined. Praxis and visuospatial skills remained intact. She did not experience pathological elation, delusions, or hallucinations. The disease followed a relentless progression into a partial Klüver-Bucy syndrome, abulia, and terminal dementia. She died from acute myocardial infarction 8 years after the onset of aphasia. The symptoms and their temporal course supported a diagnosis of logopenic variant of primary progressive aphasia due to asymmetric temporal variant frontotemporal lobar degeneration.

Conclusions: This report gives a pictorial description of a temporal variant of frontotemporal dementia in a patient who presented with worsening of a lifelong obsessive-compulsive disorder and logopenic variant of primary progressive aphasia.

Keywords: Acquired compulsions; Case report; Frontotemporal dementia; Logopenic variant of primary progressive aphasia; Obsessive–compulsive disorder; Ritualistic behaviors; Temporal variant FTD.

Fig. 1

T1-weighted MRI coronal slices through the anterior (upper row), middle (middle row), and posterior (bottom row) third of the cerebral hemispheres. Atrophy is most marked in the temporal lobes, more so on the right, as indicated by the wider Sylvian fissure and temporal horn on this side. The lateral ventricles are also symmetrically enlarged

Fig. 2

Upper row: ¹⁸FDG-PET scan showing bilateral hypometabolism in the anterior temporal cortex. The metabolism of the orbitofrontal cortex as well as the caudate nucleus and thalamus is bilaterally normal. Lower row: T1-weighted MRI showing severe bilateral anterior temporal lobe atrophy with relative sparing of the frontal, parietal, and occipital lobes

Fig. 3

The regions of interest (ROIs) of the frontal and temporal lobes used in the volumetric comparison are displayed on the left. On the right, the reduction of cortical grey matter over a 1-year time span is displayed in a bar chart. The x axis represents the analyzed cerebral regions, while the y axis represents the percentage volume loss in the right (blue bar) and left (orange bar) hemispheres