BMC Psychiatry (Aug 2012)

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

  • Kanehisa Masayuki,
  • Morinaga Katsuhiko,
  • Kohno Hisae,
  • Maruyama Yoshihiro,
  • Ninomiya Taiga,
  • Ishitobi Yoshinobu,
  • Tanaka Yoshihiro,
  • Tsuru Jusen,
  • Hanada Hiroaki,
  • Yoshikawa Tomoya,
  • Akiyoshi Jotaro

DOI
https://doi.org/10.1186/1471-244X-12-132
Journal volume & issue
Vol. 12, no. 1
p. 132

Abstract

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Abstract 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.

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