@article{ref1,
title="Severe disinhibition due to injuries of neural tracts related to emotion circuit in a patient with traumatic brain injury: a case report",
journal="Medicine (Baltimore)",
year="2017",
author="Jang, Sung Ho and Kwon, Hyeok Gyu",
volume="96",
number="52",
pages="e9493-e9493",
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.<br><br>Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0025-7974",
doi="10.1097/MD.0000000000009493",
url="http://dx.doi.org/10.1097/MD.0000000000009493"
}