Journal of Neurology

, Volume 257, Issue 10, pp 1628–1632 | Cite as

“Habit” gambling behaviour caused by ischemic lesions affecting the cognitive territories of the basal ganglia

  • Emmanuel Cognat
  • Julien Lagarde
  • Caroline Decaix
  • Elodie Hainque
  • Louisa Azizi
  • Veronique Gaura-Schmidt
  • Valerie Mesnage
  • Richard Levy
Original Communication


We report the case of a patient suffering from sudden apathy and pathological gambling-like behaviour after bilateral ischemic lesions involving the dorsal portion of the head of the caudate nuclei and adjacent anterior limb of the internal capsules. This is the first report of the association of an apathy and abnormal gambling behaviour following a stroke affecting sub-cortical structures. Although the location of the lesions, affecting the dorsal striatum, may explain the emergence of an apathetic state, it is, however, at first sight, not easy to explain the gambling behaviour because the patient was normal in tests evaluating sensitivity to reward, and no radiological abnormality was found in the cortical-sub-cortical system of reward. It is proposed that, for this patient, the mechanism of maladaptive gambling behaviour was the development of a routine behaviour related to the patient’s cognitive inertia, a mechanism different from the changes in reward sensitivity observed after damage to the orbital ventral prefrontal–ventral striatum system or in dopamine dysregulation syndrome in Parkinson’s disease.


Basal ganglia Caudate nucleus Stroke Apathy Pathological gambling 



The authors would like to thank Mrs. Kristine Smith for editorial suggestions.

Conflict of interest statement



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Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Emmanuel Cognat
    • 1
  • Julien Lagarde
    • 1
  • Caroline Decaix
    • 1
  • Elodie Hainque
    • 1
  • Louisa Azizi
    • 2
  • Veronique Gaura-Schmidt
    • 3
  • Valerie Mesnage
    • 1
  • Richard Levy
    • 1
    • 4
    • 5
  1. 1.AP-HP, Service de NeurologieHopital Saint-AntoineParis Cedex 12France
  2. 2.AP-HP, Service de RadiologieHopital Saint-AntoineParisFrance
  3. 3.AP-HP, Service de Médecine NucléaireHopital Saint-AntoineParisFrance
  4. 4.Centre de Recherche de l’Institut du Cerveau et de la Moelle EpinièreUniversité Pierre et Marie Curie-Paris 6ParisFrance
  5. 5.Inserm, U975ParisFrance

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