Abstract Details

Title Abrupt Disruption of Nicotine Addiction and Apathy after a Strategic Acute Brain Ichemia

Topic Behavioral Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 123

Objective

Background BACKGROUND: Cigarette addiction is related to the reward pathway that includes the tegmental area connected by the medial forebrain bundle (MFB) to the hypotalamus, accumbens nucleus (NAcc) and the fronto orbital cortex (FO). Apathy is related to the damage of the cingulated gyrus and disruption of networks connecting frontal structures with caudate nucleus, pallidum and thalamus.

Design/Methods DESIGN/METHODS: RMI 1,5 tesla MRI and DTI, neuropsychiatric and cognitive assessment.

Results RESULTS: A 62 year old patient with a history of active smoker (30 pack/year), Fagerstrom Nicotine Dependence Scale: 6 developed sudden onset of apathy (Starkstein Apathy Scale:38) with spontaneous cessation of cigarette smoking without withdrawal symptoms. Social withdraw and indifference was reported by relatives. No significant depressive symptoms were detected. Social Perception measured by "Reading the Mind in the Eyes" Test was abnormal. MRI showed an acute right FO stroke (medial and lateral FO cortex, frontal pole and underneath white matter); DTI showed decreased fiber density of cingulated bundle, uncinate faciculus and medial forebrain bundle in the right. NAcc was preserved. Old ischemic strokes located in the left caudate head and pallidum were detected as well.

Conclusions CONCLUSIONS: Immediate smoke cessation without withdrawal symptoms was observed after a FO lesion with disruption of pathways related to reward. Apathy is unusual in a small frontoorbital lesion. The cingulum bundle was affected without any evidence of anterior cingulum injury, suggesting that some circuits from FO cortex that are passing trough were theoretically related to apathy development. Apathy and smoke cessation could have been related to a "functional" bilateral fronto-subcortical circuit damage due to the combination of old left pallidal and caudate stroke with a deaferentation of the right basal ganglia.

Authors/Disclosures
PRESENTER	No disclosure on file
Marcos C. Fernandez Suarez, MD (FLENI)	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
	No disclosure on file
Alejandra Amengual	No disclosure on file
	No disclosure on file
Griselda Russo, MD	No disclosure on file
Ricardo F. Allegri, MD, PhD, FAAN (Institute for Neurological Research (FLENI))	Dr. Allegri has nothing to disclose.
Robert Stern, PhD (Boston University School of Medicine)	Robert Stern, PhD has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biogen. The institution of Robert Stern, PhD has received research support from Eisai. The institution of Robert Stern, PhD has received research support from Lilly. The institution of Robert Stern, PhD has received research support from ATRI/NIA. Robert Stern, PhD has received publishing royalties from a publication relating to health care. Robert Stern, PhD has a non-compensated relationship as a Member with NFLPA Mackey-White Committee that is relevant to AAN interests or activities.

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