CT pre-contrast

Diagnosis: Bifrontal lobotomy

The discoverer of bifrontal lobotomy (leukotomy) Egas Moniz received the 1949 Noble Prize in Medicine for this procedure. It became popular in the 1950's for treatment of refractory psychiatric disorders and was performed until the late 1960's. In addition to the behavioral changes, long term effects from bifrontal lobotomy include seizures, minor motor defects, and prefrontal release signs such as snout and root reflexes. One study followed 14 lobotomized schizophrenic patients and reported that 4 of them had committed a homicide at some point after after the operation. Imaging findings in patients who have been lobotomized include symmetric low attenuation in the frontal white matter, localized frontal cortical atrophy, and bony defects in the overlying frontal bones. Other considerations in the differential may include prior bifrontal craniotomy or perhaps head trauma. This patient received a bifrontal lobotomy in the 1950's.

Hakola HP, Puranen M, Repo L, et al. Long term effects of bilateral lobe lesions from neuropsychiatric and neuroradiological aspects. Dementia, Mar-Apr 1993; 4(2):p109-12.

Dorman J. The history of psychosurgery. Texas Medicine, Jul 1995; 91(7):p54-61.