title: An unusual case of random fire-setting behavior associated with lacunar stroke.
abstract: A case of a 47-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 impairment. Axial T1-weighted magnetic resonance imaging showed a low intensity lacunar lesion in the genu and anterior limb of the left internal capsule. A neuropsychological test battery revealed lower than normal scores for executive functions, attention and memory, consistent with frontal lobe dysfunction. The recent onset of fire-setting behavior and the chronic nature of the lacunar lesion, together with an unremarkable performance on tests measuring executive functions two years prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The present case describes a rare and as yet unreported association between random impulse-driven fire-setting behavior and damage to the left internal capsule and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.
authors.affiliation: Clienia, Psychiatric Outpatient Facility, Wetzikon, Switzerland. h_bosshart@bluewin.ch
authors.forename: Herbert
authors.initials: H
authors.lastname: Bosshart
authors.forename: Sonia
authors.initials: S
authors.lastname: Capek
mesh_terms: D000377:Agnosia / Q000209:etiology; D020520:Brain Infarction / Q000150:complications / Q000175:diagnosis*; D056344:Executive Function; D005391:Firesetting Behavior / Q000209:etiology* / Q000523:psychology; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests