title: Late-onset social anxiety disorder following traumatic brain injury.
abstract: BACKGROUND
  Neuropsychiatric sequelae are the predominant long-term disability after traumatic brain injury (TBI). This study reports a case of late-onset social anxiety disorder (SAD) following TBI.
  
  
  METHODS
  A patient that was spontaneous and extroverted up to 18-years-old started to exhibit significant social anxiety symptoms. These symptoms became progressively worse and he sought treatment at age 21. He had a previous history of traumatic brain injury (TBI) at age 17. Neuroimaging investigations (CT, SPECT and MRI) showed a bony protuberance on the left frontal bone, with mass effect on the left frontal lobe. He had no neurological signs or symptoms. The patient underwent neurosurgery with gross total resection of the lesion and the pathological examination was compatible with intradiploic haematoma.
  
  
  CONCLUSIONS
  Psychiatric symptoms may be the only findings in the initial manifestation of slowly growing extra-axial space-occupying lesions that compress the frontal lobe from the outside. Focal neurological symptoms may occur only when the lesion becomes large. This case report underscores the need for careful exclusion of general medical conditions and TBI history in cases of late-onset SAD and may also contribute to the elucidation of the neurobiology of this disorder.
authors.affiliation: Department of Neuroscience and Behavior, Ribeirão Preto Medical School, University of São Paulo, Brazil.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Chaves
authors.forename: Clarissa
authors.initials: C
authors.lastname: Trzesniak
authors.forename: Guilherme Nogueira
authors.initials: GN
authors.lastname: Derenusson
authors.forename: David
authors.initials: D
authors.lastname: Araújo
authors.forename: Lauro
authors.initials: L
authors.lastname: Wichert-Ana
authors.forename: João Paulo
authors.initials: JP
authors.lastname: Machado-de-Sousa
authors.forename: Carlos Gilberto
authors.initials: CG
authors.lastname: Carlotti
authors.forename: Antonio E
authors.initials: AE
authors.lastname: Nardi
authors.forename: Antônio W
authors.initials: AW
authors.lastname: Zuardi
authors.forename: José Alexandre
authors.initials: JA
authors.lastname: de S Crippa
authors.forename: Jaime E C
authors.initials: JE
authors.lastname: Hallak
mesh_terms: D001008:Anxiety Disorders / Q000175:diagnosis / Q000209:etiology*; D001930:Brain Injuries / Q000523:psychology*; D005625:Frontal Lobe / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000175:diagnosis* / Q000523:psychology* / Q000601:surgery; D008297:Male; D059906:Neuroimaging; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult