• Sung Ho Jang and Hyeok Gyu Kwon.
• Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Gyeongsan Department of Physical Therapy, College of Health Sciences, Catholic University of Pusan, Busan, Repu... more blic of Korea. less
• Medicine (Baltimore). 2017 Dec 1; 96 (52): e9493e9493.

RationaleApproximately 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 ConcernsA 27-year-old male patient suffered an in-car accident.DiagnosesSince 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.InterventionsN/A.OutcomesOn 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.LessonsUsing 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.Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

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