title: An uncommon case of random fire-setting behavior associated with Todd paralysis: a case report.
abstract: BACKGROUND
  The association between fire-setting behavior and psychiatric or medical disorders remains poorly understood. Although a link between fire-setting behavior and various organic brain disorders has been established, associations between fire setting and focal brain lesions have not yet been reported. Here, we describe the case of a 24-year-old first time arsonist who suffered Todd's paralysis prior to the onset of a bizarre and random fire-setting behavior.
  
  
  METHODS
  A case of a 24-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 disturbances with leg weakness. A video-EEG recording demonstrated a close relationship between the focal motor impairment and a clear-cut epileptic ictal discharge involving the bilateral motor cortical areas. The SPECT result was statistically analyzed by comparing with standard SPECT images obtained from our institute (easy Z-score imaging system; eZIS). eZIS revealed hypoperfusion in cingulate cortex, basal ganglia and hyperperfusion in frontal cortex,. A neuropsychological test battery revealed lower than normal scores for executive function, attention, and memory, consistent with frontal lobe dysfunction.
  
  
  CONCLUSIONS
  The fire-setting behavior and Todd's paralysis, together with an unremarkable performance on tests measuring executive function fifteen months prior, suggested a causal relationship between this organic brain lesion and the fire-setting behavior. The case describes a rare and as yet unreported association between random, impulse-driven fire-setting behavior and damage to the brain and suggests a disconnection of frontal lobe structures as a possible pathogenic mechanism.
authors.affiliation: Department of Neuropsychiatry, Oita University Faculty of Medicine, Oita, Hasama-Machi, 879-5593, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Kanehisa
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Morinaga
authors.forename: Hisae
authors.initials: H
authors.lastname: Kohno
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Taiga
authors.initials: T
authors.lastname: Ninomiya
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Ishitobi
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tanaka
authors.forename: Jusen
authors.initials: J
authors.lastname: Tsuru
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hanada
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Jotaro
authors.initials: J
authors.lastname: Akiyoshi
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D058256:Brain Waves / Q000502:physiology; D004569:Electroencephalography / Q000523:psychology; D005391:Firesetting Behavior / Q000150:complications* / Q000000981:diagnostic imaging / Q000523:psychology*; D059907:Functional Neuroimaging; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000523:psychology; D008297:Male; D059906:Neuroimaging / Q000523:psychology; D009483:Neuropsychological Tests; D010243:Paralysis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000523:psychology*; D015899:Tomography, Emission-Computed, Single-Photon / Q000523:psychology; D055815:Young Adult