Psychosis or temporal lobotomy: SPECT findings in a paraplegic patient with chronic mental illness

To ascertain if single proton emission computerized tomography (SPECT) imaging involving a patient with a history of head trauma, paraplegia, and chronic mental illness, would provide useful information regarding diagnosis and treatment.

A case report.

SPECT data indicated a convexity of the temporal lobe; it was significantly crumpled inward in the location of the traumatic blow suffered 18 years earlier. The center of hypoperfusion suggested a complete disruption of connections between the temporal lobe and Broca's area, and a practically ablated left temporal area.

The patient was reclassified with an organic psychosis and as an individual who might benefit more from medications to treat temporal lobe irritability rather than antipsychotic medications. Despite these findings and recommendations, psychiatric personnel discharged the patient without implementation. He is currently in critical condition following a suicide attempt.