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Radiologic Findings: CT and MRI findings: On CT scan there are symmetric areas of decreased attenuation in frontal lobes bilaterally. The process is confined to white matter (Fig 1a). There is evidence of bifrontal burr holes (Fig 1b). Coronal T/1 MRI (Fig.2) shows symmetric areas of decreased signal.
Intensity in frontal lobes with minimal associated cortical atrophy and prominent sulci. The burr holes are seen as bony defects. Axial T/2 (Fig 3) demonstrates hyperintense areas in white matter corresponding to T/1 images.
Diagnosis: Frontal lobotomy
Discussion: Frontal lobotomy was used for control of schitzophrenia. In 1954, prefrontal sonic treatment was introduced as a substitute to frontal lobotomy(1). Both procedures cause similar findings of malacic changes in frontal lobes, confined to white matter(2). Pathologically these areas show necrosis in the white matter with no significant necrosis of the cerebral cortex(1). There is destruction of the myelin in the white matter with gliosis and scarring. In use of ultrasonic irradiation the pathology is limited to beam path, while in surgical lobotomy the necrosis is more diffuse and extensive. Previous contusion from head trauma and brain radiation to frontal lobes can have similar CT and MRI appearance.
References:
Lindstrom PA. Prefrontal Ultrasonic Irradiation - A Substitute for Lobotomy.
Arch Neurol Psychiat 1954;72:399-425.
Kahn L, Heiserman JE, Hodak JA, Foster CA. Prefrontal Sonic Treatment:
MR Findings. AJNR 1992;13:1493-1494.
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