Bilateral Stereotactic Anterior Cingulotomy is Effective in the Treatment of Drug-Resistant Psychosis and Impulse Control Disorders Caused by Traumatic Brain Injury: A Case Report

Background: Psychotic disorders due to traumatic brain injury (PDDTBI) represent severe form of neuropsychiatric problems that can occur after traumatic brain injury (TBI). Some patients develop treatment-refractory psychiatric symptoms. Psychosurgery is a viable option with good efficacy in such debilitating cases. Objective: To report efficacy of anterior cingulotomy for suppressing intractable psychotic and impulsive symptoms caused by TBI. Case Report: The authors report a case of 37-year-old male with a history of TBI which required craniectomy with hematoma evacuation and subsequent cranioplasty. He developed severe paranoid delusion with auditory hallucination, anxiety and impulsivity. The patient was admitted to the psychiatric hospital for recurrent, severe, treatment-refractory psychotic symptoms and impulsivity. Despite multiple drug regimens, his psychiatric symptoms did not improve. He underwent psychosurgery using bilateral anterior cingulotomy. Results: His symptoms were significantly improved after the surgery. His delusion, hallucination and impulsivity disappeared and his mood became stable. He could resume daily activity. There was no recurrent symptom at 2 years postoperatively. Conclusion: Anterior cingulotomy is an effective treatment option for refractory PDDTBI, especially if the psychotic manifestation coincides with affective symptoms.