Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
The existence of a focal brain lesion that might be the crucial cause for the development of diverse psychiatric phenomena and certain characteristics of personality is often a
controversial issue. The patient was a 29-year-old male when he killed his father with a single knock with the blunt side of an axe. Subsequently to the act, the patient developed a 10-month-long catatonic stupor during which he experienced intensive fear, delusions, and affective symptoms. He was an emotionally blunted person with no medical record and without prior history of aggressive behavior. Magnetic resonance image revealed a large, right-sided arachnoid cyst that was associated with right temporal and frontal lobe hypoplasia and bilateral changes of perfusion in peri-insular regions. The treatment with clozapine and diazepam showed to be therapeutic. This could be the second case of homicide committed by a person with arachnoid cyst and without past history of aggression, and the second description of an adult patient with cyst who developed catatonic stupor. This is the first description of long-lasting organic catatonic stupor treated with clozapine and diazepam. Relevant literature is reviewed and some controversial issues are discussed.Razvoj različitih psihijatrijskih sindroma ili promjena značajka osobnosti može biti povezana sa žarišnim ozljedama mozga, ali je ujedno i proturječno pitanje. Bolesnik, inače osoba bez osobitosti u ranijoj medicinskoj dokumentaciji i bez ranijih iskazivanja fizičke agresije, imao je 29 godina kada je ubio oca jednim udarcem sjekire. Nakon djela razvio je dugotrajni, desetomjesečni katatoni stupor tijekom kojeg je doživljavao intenzivni strah, sumanutosti i afektivne simptome. Pretraga glave magnetskom rezonancom otkrila je veliku desnostranu arahnoidnu cistu povezanu s hipoplazijom desnog temporalnog i frontalnog režnja te bilateralnim promjenama u perfuziji periinzularnih regija. Liječenje klozapinom i diazepamom pokazalo se učinkovitim. Ovo je vjerojatno drugi prikaz bolesnika s arahnoidnom cistom koji je počinio ubojstvo, a da prethodno nije pokazivao agresivno ponašanje te drugi prikaz bolesnika s cistom koji je razvio katatoni stupor. Radi se također o prvom opisu uspješnog liječenja dugotrajnog katatonog stupora kombinacijom klozapina i diazepama. Slučaj je poslužio za prikaz relevantne literature i raspravu o proturječnim pitanjima
