Format

Send to

Choose Destination
Medicine (Baltimore). 2017 Dec;96(52):e9493. doi: 10.1097/MD.0000000000009493.

Severe disinhibition due to injuries of neural tracts related to emotion circuit in a patient with traumatic brain injury: A case report.

Author information

1
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Gyeongsan.
2
Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Republic of Korea.

Abstract

RATIONALE:

Approximately 30% of patients with traumatic brain injury (TBI) develop disinhibition, a condition that involves several brain structures, including the amygdala, orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC). Using diffusion tensor tractography (DTT), we report on a patient with severe disinhibition and injuries of the amygdala, OFC, and ACC following TBI.

PATIENT CONCERNS:

A 27-year-old male patient suffered an in-car accident.

DIAGNOSES:

Since the onset of the TBI, the patient showed severe disinhibition including violence, as follows: 1) he sometimes attacked therapists and nurses with no provocation, 2) while he was laying on a bed, he shouted and kicked the bed when asked questions, and 3) during therapy with a difficult task, he behaved violently to a therapist. The subscale of disinhibition in Neuropsychiatric Inventory scored three points for severity and for distress.

INTERVENTIONS:

N/A.

OUTCOMES:

On 10-month DTT, the connectivity of amygdala to the prefrontal cortex including the medial prefrontal cortex and OFC had decreased in both hemispheres. In the prefronto-thalamic tracts, the orbitofronto-thalamic tractshad narrowed (the right hemisphere), and were non-reconstructed (the left hemisphere). Discontinuations of both anterior cingulums were observed in both hemispheres.

LESSONS:

Using DTT, concurrent injuries of the amygdala, OFC, and ACC were demonstrated in a patient with severe disinhibition following TBI. Our result suggests the need to assess these neural structures in patients with disinhibition after brain injury.

PMID:
29384946
PMCID:
PMC6392766
DOI:
10.1097/MD.0000000000009493
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wolters Kluwer Icon for PubMed Central
Loading ...
Support Center