Stroke-Induced Othello Syndrome: A Case of Delusional Jealousy
A recent case report published in the journal Neurocase details a striking instance of Othello syndrome, a rare psychiatric condition characterized by delusional jealousy, which emerged in a 50-year-old woman following a stroke. The case underscores the profound impact that brain damage can have on behavior and perception, particularly in the realm of intimate relationships.
The woman, who had no prior history of psychiatric illness, experienced a sudden and intense headache while preparing a meal. This led to confusion and memory problems, prompting her to seek emergency medical assistance. Imaging studies revealed she had suffered a bilateral paramedian thalamic infarct, a rare type of stroke involving blockages in the artery of Percheron, which supplies blood to both sides of the thalamus. The thalamus is crucial for regulating attention, emotion, and sensory processing, and its damage can lead to significant alterations in behavior.
According to Dr. Ghita Hjiej, a leading researcher at the University of Rabat and co-author of the case report published in 2025, the condition can manifest as a fixed belief that a partner is unfaithful, persisting despite evidence to the contrary. In this particular case, the woman became convinced that her husband was cheating, initially accusing her sister and then shifting her suspicion to her friend’s daughter. Her behavior escalated to violent confrontations, including two separate attacks on her husband with a weapon. Such aggressive behaviors highlight the potential dangers associated with Othello syndrome, particularly when linked to neurological impairments.
Psychiatric evaluations revealed cognitive decline in the patient, with scores indicating impairment on commonly used cognitive screening tools. Clinicians ruled out other potential causes for her symptoms, attributing her psychiatric issues directly to the stroke. Treatment with antipsychotic medications, initially with quetiapine and later olanzapine, effectively managed her symptoms over time. The woman eventually recognized her delusional beliefs as false and ceased viewing her husband with suspicion.
Othello syndrome is particularly intriguing as it has been observed in various contexts, often in individuals with psychiatric disorders, substance use issues, or neurological conditions. The right hemisphere of the brain, especially areas surrounding the thalamus, is often implicated in such cases, leading to impaired judgment and heightened suspiciousness. Dr. Maha Abdellaoui, another co-author of the study, noted that while psychotic symptoms following strokes are not common, delusional jealousy is one of the more frequently reported subtypes.
This case not only exemplifies the potential for brain injuries to manifest as severe psychological conditions but also emphasizes the importance of early recognition and intervention. The authors of the study caution that while this case is noteworthy, it cannot establish prevalence rates or predict outcomes for other patients with similar injuries. Nonetheless, the findings contribute valuable insights into how brain damage can lead to profound changes in behavior and personality, extending beyond cognitive deficits to include severe emotional disturbances.
In summary, the emergence of Othello syndrome following a stroke illustrates the critical intersections of neurology and psychology. Future research could benefit from exploring the mechanisms underlying such conditions further, potentially leading to improved treatment protocols and outcomes for individuals affected by similar syndromes. As noted by Dr. Hicham El Otmani, a neurologist involved in the case, understanding the relationship between brain function and psychological health is key in addressing the complexities of conditions like Othello syndrome.
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