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

BMC Psychiatry. 2012 Aug 31;12:132. doi: 10.1186/1471-244X-12-132.

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.

Publication types

  • Case Reports

MeSH terms

  • Brain / diagnostic imaging
  • Brain / pathology
  • Brain / physiopathology
  • Brain Waves / physiology
  • Electroencephalography / psychology
  • Firesetting Behavior / complications*
  • Firesetting Behavior / diagnostic imaging
  • Firesetting Behavior / psychology*
  • Functional Neuroimaging
  • Humans
  • Magnetic Resonance Imaging / psychology
  • Male
  • Neuroimaging / psychology
  • Neuropsychological Tests
  • Paralysis / complications*
  • Paralysis / diagnostic imaging
  • Paralysis / physiopathology
  • Paralysis / psychology*
  • Tomography, Emission-Computed, Single-Photon / psychology
  • Young Adult