After A Cosmetic Surgery, A Patient Can’t Stop The Urge To Steal!

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Postcontrast, T1-weighted brain MRI demonstrating heterogeneous enhancement in bilateral putamen and head of caudate nuclei.

Cosmetic surgery not only gave a 40-year-old woman a flat abdomen and enhanced breasts but also a strong urge to spontaneously shoplift!

A 40-year-old Brazilian woman presented after a plastic surgery done for aesthetic gains with complaints of recurring and intrusive thoughts along with irresistible compulsion to steal. Her procedures included liposuction, a tummy tuck, breast augmentation and an arm lift.

The patient had an uneventful cosmetic surgery, although, in the immediate postoperative period, she was somnolent, disoriented, lethargic, uninterested, and had memory deficits. The patient had no history of any medical or psychiatric condition, nor she had a relevant family history.

A magnetic resonance imaging of the brain was performed, which showed bilateral nucleocapsular hypoxic-ischemic injury.

 Cerebral perfusion scintigraphy showed relative hypoperfusion in the

  • frontal lobes (figure A)
  • anterior portions of the cingulate gyri (figure B)
  • basal ganglia (right more than left) (figure C)
  • cerebella (figure D).

The patient was discharged after he had improved. During the following days, she had thoughts of stealing, relieved only after the act.

The patient was diagnosed with transitory (temporary) kleptomania/impulse control disorder.

It was presumed that during the surgery or soon after the procedure, a temporary inadequacy in the blood flow to the brain must have caused hypoxic injuries to some parts of the brain.

Dr. Fabio Nascimento, a neurologist at Toronto Western Hospital in Canada who was part of the medical team during her hospitalization in Brazil at the time of the case, said:

“Such a restricted blood flow could have deprived the woman’s brain of oxygen and nutrients, resulting in disrupted brain function and leading to brain damage. This damage likely interfered with certain circuits within her brain, causing the neurological symptoms observed after the surgery.”

Her episodes of kleptomania resolved spontaneously after a couple of weeks. During this time, she hadn’t been in any trouble with the law.

Hypoxic-ischemic injury of the brain either during surgery or due to trauma can have variable neuropsychiatric outcomes, including cognitive impairment, memory deficits, language problems, personality, behavioral and emotional changes including impulsiveness, distractibility, and irritability.

“The medical literature has reported on a few other cases of kleptomania after traumatic brain injury or neurosurgery, or after brain cells receive a lack of oxygen like this woman did. But it is a very unusual occurrence”, Nascimento said.

“They usually resolve without any treatment,” he added.

References:

Nascimento FA, Guebert M, Rizelio V, et al, Kleptomania following hypoxic-ischaemic damage to bilateral caudate nuclei. Case Reports 2016;2016:bcr2015213710.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th edn. Washington DC: American Psychiatric Association, 2013:478–80

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Dr. Arsia Parekh
Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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