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

Interrupción brusca de la adicción a la nicotina y la apatía tras una isquemia cerebral aguda estratégica

Resumen

Cigarette addiction shares common physiopathological mechanisms with other abuse drugs, mainly related to the brain reward circuits (1). Apathy is a neuropsychiatric disorder mostly related to cingulated gyrus damage, superior medial frontal and to disruption of neural networks connecting frontal structures with caudate nucleus, globus pallidus and thalamic nuclei (2). We describe a 62 year old patient with a history of severe smoking and hypertension who developed an abrupt disruption of nicotine addiction and apathy after ischemic stroke located in the left caudate head and the left pallidum area. The anatomic involvement of the rewards circuit areas are closely related to the abrupt cessation of smoking due to isquemic lesions descripted (3)(4). We hypothesize that apathy and smoking cessation could be related to “functional” bilateral fronto-subcortical circuit damage due to a combination of left pallidal and caudate stroke with a deaferentation of the right basal ganglia (3).