Abstract
BackgroundThe 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 presentationA 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.ConclusionThe 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.
Highlights
The association between fire-setting behavior and psychiatric or medical disorders remains poorly understood
The single-photon emission computed tomography (SPECT) result was statistically analyzed by comparing with standard SPECT images obtained from our institute. easy Z-score imaging system (eZIS) revealed hyperperfusion in frontal cortex (Figure 2). eZIS from ictal – interictal ECD-SPECT showed hyperperfusion in the frontal cortex (Figure 3). eZIS from interictal – ictal Tc-99 m ECD-SPECT showed hypoperfusion in cingulate cortex, basal ganglia (Figure 4)
Arson is frequently associated with psychiatric morbidity and with previous non-violent or violent offences [15]
Summary
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, impulsedriven fire-setting behavior and damage to the brain and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism. Competing interests Authors have no competing interests to declare that are relevant to the content of this submission. YM and TN participated in EEG study. YI and YT examined SPECT study, HK, JT and HH examined psychological test examination, JA planed the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript
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