Punding as a Complication of Brain Stem Stroke?

Abstract

Background and Purpose— 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. Summary of Case— 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. Conclusion— 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.