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Open Access Case report

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

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

Author Affiliations

1 Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Hasama-Machi, 879-5593, Japan

2 FUJIFILM RI Pharma Co., Ltd., Tokyo, 104-0031, Japan

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BMC Psychiatry 2012, 12:132  doi:10.1186/1471-244X-12-132

Published: 31 August 2012

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.

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