RESUMO
Intermittent explosive disorder (IED) is characterized by a dysfunction in the greater limbic system leading an individual to experience sudden aggressive behavior with little or no environmental perturbation. This report describes a procedure for the treatment of IED in a 19-year-old woman with a history of IED, having had episodes of severe violent attacks against family, dating to early childhood. Due to the severity and intractability of the illness, deep brain stimulation was performed, targeting the orbitofrontal projections to the hypothalamus. The patient's history and the procedure, management, and rationale are described in detail.
Assuntos
Estimulação Encefálica Profunda/métodos , Transtornos Disruptivos, de Controle do Impulso e da Conduta/terapia , Lobo Frontal/fisiologia , Hipotálamo/fisiologia , Adulto , Agressão/psicologia , Transtornos Disruptivos, de Controle do Impulso e da Conduta/cirurgia , Feminino , Humanos , Cápsula Interna/fisiologia , Sistema Límbico/cirurgia , Vias Neurais/fisiologia , Núcleo Accumbens/fisiologia , Satisfação do Paciente , Putamen/fisiologia , Qualidade de Vida/psicologia , Núcleos Septais/fisiologia , Resultado do TratamentoRESUMO
The cases of 2 children with true aneurysmal subarachnoid hemorrhages (SAHs) and initial false-negative angiograms are reported. In both cases, the initial angiogram was of adequate technical quality and included the projections on which aneurysms were later documented. There was no significant vasospasm at the time of initial angiography; therefore, transient aneurysm sac thrombosis was the most likely explanation for the initial false-negative studies. It is particularly interesting to note that 1 of the 2 patients had a pattern of hemorrhage compatible with the most limited definition of a perimesencephalic SAH, that is, a small prepontine cistern hemorrhage. If a second angiogram had been deemed unnecessary based on that criterion alone, a ruptured basilar tip aneurysm would have escaped detection and treatment.