Hypersexuality and hemiballism due to subthalamic infarction.
OBJECTIVE
A 70-year-old right-handed man presented with a subthalamic infarction followed by persistent hypersexuality and hemiballism. A lacunar infarction 1 cm in diameter was observed on magnetic resonance imaging. We hypothesized that metabolic abnormalities would be detected in cortical areas related to his neurobehavioral symptoms.


BACKGROUND
Statistical validation of the regional metabolic changes that may relate to neuropsychiatric symptoms has been elusive. Relating metabolic changes to neuropsychiatric symptoms is especially important in unique neurobehavioral cases.


METHODS
Quantitative fluorodeoxyglucose positron emission tomography was obtained for a single-subject comparison with scans from 60 healthy subjects.


RESULTS
Substantial glucose hypometabolism (p <0.001, uncorrected; [df = 56]) was identified in the subthalamic nucleus at the site of the lacunar infarction. Hypermetabolism (p <0.01) was identified within the basal forebrain and temporal lobes, anterior cingulate and medial prefrontal cortices (areas previously associated with hypersexuality), and striatum (p <0.001) ipsilateral to the stroke (areas known to relate to hemiballism).


CONCLUSIONS
Single-subject statistical parametric mapping may improve our understanding of unique neurobehavioral cases.
Absher
J R
JR
Department of Neurology, Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina, USA. jrabsher@bellsouth.net
Vogt
B A
BA
Clark
D G
DG
Flowers
D L
DL
Gorman
D G
DG
Keyes
J W
JW
Wood
F B
FB
D000368:Aged; D001921:Brain / Q000098:blood supply / Q000378:metabolism / Q000473:pathology*; D016022:Case-Control Studies; D002544:Cerebral Infarction / Q000150:complications* / Q000378:metabolism / Q000473:pathology; D004292:Dominance, Cerebral; D020820:Dyskinesias / Q000209:etiology*; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007989:Libido; D008279:Magnetic Resonance Imaging; D008297:Male; D019275:Radiopharmaceuticals; D020531:Subthalamic Nucleus / Q000378:metabolism / Q000473:pathology*; D014055:Tomography, Emission-Computed
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18