Othello Syndrome After Cerebrovascular Infarction

A 65-year-old man presented at our hospital with sudden onset left hemianopia and left mild hemiparesis. MRI showed right temporoparietoinsular ischemic lesion (Figure 1). Etiological investigation identified an occluded right internal carotid. One week later, he started accusing his wife of having a sexual relationship with one of their sons, insisting on a paternity test of their youngest daughter, as he was certain that she was the result of an incestuous relationship. He also believed that he was in danger of being murdered by his wife for knowing of this imagined relationship. He was treated with fluvoxamine and chlorpromazine, with symptomatic relief over the following weeks. At 6-month follow-up, he still had nondisruptive residual delusional activity.

A 69-year-old man presented at our hospital for sudden-onset euphoria, left hemianopia, and very mild left hemiparesis. The patient had an outstanding elation, laughed inappropriately, continuously shouted that he trusted in Medicine, called the doctor whom he had never seen before the “King of Medicine,” and over complied with neurological exploration, clownishly waving his arms and legs. MRI showed a temporoparietoinsular right ischemic lesion (Figure 2). Etiological investigation identified an occlusion of the right internal carotid. On the second day, he started being jealous of his wife, thinking that she was involved with other patients on his ward. Over the following weeks, he started accusing her of being sexually involved with his oldest son (of a previous marriage). He was treated with sertraline and quetiapine, with complete resolution of the delusional activity over the next 4 months.