Punding as a complication of brain stem stroke?: report of a case.
OBJECTIVE
Stereotyped motor behaviors, known as "punding," originally described among amphetamine abusers have only recently been reported in Parkinson disease associated with both pro-(eg, levodopa) or anti-(eg, quetiapine) dopaminergic therapy. We describe a non-Parkinson disease case of nonpharmacologically induced punding as a complication of a brain stem cardiovascular accident.


METHODS
A 54-year-old man, after an episode of brain stem cardiovascular accident secondary to basilar artery thrombosis, was noted to endlessly purchase and hoard food items and to write, copy and organize recipes. His activity was excessive, disruptive and affected his interaction with family members. The patient's punding behaviors significantly improved with an increased dose of sertraline from 100 mg to 150 mg per day.


CONCLUSIONS
Our patient's presentation was most consistent with punding, but interestingly was not a result of dopaminergic therapy. Moreover, improvement of his behavior was noted with a selective serotonin reuptake inhibitor, further questioning the dopaminergic hypothesis of punding.
Nguyen
Frederic N
FN
Department of Neurology, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Pauly
Rebecca R
RR
Okun
Michael S
MS
Fernandez
Hubert H
HH
D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D001933:Brain Stem / Q000187:drug effects / Q000378:metabolism / Q000503:physiopathology; D020526:Brain Stem Infarctions / Q000150:complications* / Q000503:physiopathology; D002533:Cerebral Angiography; D004298:Dopamine / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D012701:Serotonin / Q000378:metabolism; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D020280:Sertraline / Q000494:pharmacology / Q000627:therapeutic use; D019956:Stereotypic Movement Disorder / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000150:complications* / Q000503:physiopathology
D004298:Dopamine; D012701:Serotonin; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline