An uncommon case of random fire-setting behavior associated with Todd paralysis: A case report

BMC Psychiatry

Jotaro Akiyoshi¹  Tomoya Yoshikawa²  Hiroaki Hanada¹  Jusen Tsuru¹  Yoshihiro Tanaka¹  Yoshinobu Ishitobi¹  Taiga Ninomiya¹  Yoshihiro Maruyama¹  Hisae Kohno¹  Katsuhiko Morinaga¹  Masayuki Kanehisa¹ 

[1] Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Hasama-Machi, 879-5593, Japan;FUJIFILM RI Pharma Co., Ltd., Tokyo, 104-0031, Japan

关键词: Todd’s paresis;    Ictal paralysis;    Prolonged seizures;    Focal epilepsy;    Frontal lobe dysfunction;    Lacunar stroke;    Arson;    Fire setting;   

Others  :  1124299
DOI  :  10.1186/1471-244X-12-132

 received in 2011-10-07, accepted in 2012-05-23,  发布年份 2012

【 摘 要 】

Background

The association between fire-setting behavior and psychiatric or medical disorders remains poorly understood. Although a link between fire-setting behavior and various organic brain disorders has been established, associations between fire setting and focal brain lesions have not yet been reported. Here, we describe the case of a 24-year-old first time arsonist who suffered Todd’s paralysis prior to the onset of a bizarre and random fire-setting behavior.

Case presentation

A case of a 24-year-old man with a sudden onset of a bizarre and random fire-setting behavior is reported. The man, who had been arrested on felony arson charges, complained of difficulties concentrating and of recent memory disturbances with leg weakness. A video-EEG recording demonstrated a close relationship between the focal motor impairment and a clear-cut epileptic ictal discharge involving the bilateral motor cortical areas. The SPECT result was statistically analyzed by comparing with standard SPECT images obtained from our institute (easy Z-score imaging system; eZIS). eZIS revealed hypoperfusion in cingulate cortex, basal ganglia and hyperperfusion in frontal cortex,. A neuropsychological test battery revealed lower than normal scores for executive function, attention, and memory, consistent with frontal lobe dysfunction.

Conclusion

The fire-setting behavior and Todd’s paralysis, together with an unremarkable performance on tests measuring executive function fifteen months prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The case describes a rare and as yet unreported association between random, impulse-driven fire-setting behavior and damage to the brain and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.

【 授权许可】

   
2012 Kanehisa et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Geller JL: Pathological firesetting in adults. Int J Law Psychiatry 1992, 15(3):283-302.
• [2]Powers PS, Gunderman R: Kleine-Levin syndrome associated with fire setting. Am J Dis Child 1978, 132(8):786-789.
• [3]Brunner HG, Nelen M, Breakefield XO, Ropers HH, van Oost BA: Abnormal behavior associated with a point mutation in the structural gene for monoamine oxidase A. Science 1993, 262(5133):578-580.
• [4]Maharajh HD, Konings M: Fire setting in a patient with hyperglycaemic delirium. J Forensic Sci 2006, 51(4):940.
• [5]Shirahama M, Akiyoshi J, Ishitobi Y, Tanaka Y, Tsuru J, Matsushita H, Hanada H, Kodama K: A young woman with visual hallucinations, delusions of persecution and a history of performing arson with possible three-generation Fahr disease. Acta PsychiatrScand 2010, 121(1):75-77.
• [6]Puri BK, Baxter R, Cordess CC: Characteristics of fire-setters. A study and proposed multiaxial psychiatric classification. Br J Psychiatry 2005, 166(3):393-396.
• [7]Todd RB: Clinical lectures on paralysis, disease of the brain and other affections of the nervous system. Univ. of London, London; 1854.
• [8]Minoshima S, Frey KA, Koeppe RA, Foster NL, Kuhl DE: A diagnostic approach in Alzheimer’s disease using three-dimensional stereotactic surface projections of fluorine-18-FDG PET. J Nucl Med 1995, 36(7):1238-1248.
• [9]Matsuda H: Role of neuroimaging in Alzheimer’s disease, with emphasis on brain perfusion SPECT. J Nucl Med 2007, 48(8):1289-1300.
• [10]Matsuda H, Mizumura S, Nagao T, Ota T, Iizuka T, Nemoto K, Takemura N, Arai H, Homma A: Automated discrimination between very early Alzheimer disease and controls using an easy Z-score imaging system for multicenter brain perfusion single-photon emission tomography. AJNR Am J Neuroradiol 2007, 28(4):731-736.
• [11]Strauss E, Sherman EMS: A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. Oxford University Press, New York; 2006.
• [12]Kirchner WK: Age differences in short-term retention of rapidly changing information. J ExpPsychol 1958, 55(4):352-358.
• [13]Baldo JV, Shimamura AP, Delis DC, Kramer J, Kaplan E: Verbal and design fluency in patients with frontal lobe lesions. J IntNeuropsycholSoc 2001, 7(5):586-596.
• [14]Gläscher J, Tranel D, Paul LK, Rudrauf D, Rorden C, Hornaday A, Grabowski T, Damasio H, Adolphs R: Lesion mapping of cognitive abilities linked to intelligence. Neuron 2009, 61(5):681-691.
• [15]Repo E, Virkkunen M, Rawlings R, Linnoila M: Criminal and psychiatric histories of Finnish arsonists. Acta PsychiatrScand 1997, 95(4):318-323.
• [16]Volavka J, Martell D, Convit A: Psychobiology of the violent offender. J Forensic Sci 1992, 37(1):237-251.
• [17]Clarke HF, Dalley JW, Crofts HS, Robbins TW, Roberts AC: Cognitive inflexibility after prefrontal serotonin depletion. Science 2004, 304(5672):878-880.
• [18]Chukwudelunzu FE, Meschia JF, Graff-Radford NR, Lucas JA: Extensive metabolic and neuropsychological abnormalities associated with discrete infarction of the genu of the internal capsule. J Neurol Neurosurg Psychiatry 2001, 71(5):658-662.
• [19]Tatemichi TK, Desmond DW, Prohovnik I, Cross DT, Gropen TI, Mohr JP, Stern Y: Confusion and memory loss from capsular genu infarction: a thalamocortical disconnection syndrome? Neurology 1992, 42(10):1966-1979.
• [20]Bechara A: Decision making, impulse control and loss of willpower to resist drugs: a neurocognitive perspective. Nat Neurosci 2005, 8(11):1458-1463.
• [21]Barratt ES, Felthous AR: Impulsive versus premeditated aggression: implications for mensrea decisions. BehavSci Law 2003, 21(5):619-630.