Hypersexuality and hemiballism due to subthalamic infarction

Objective: A 70-year-old right-handed man presented with a subthalamic infa rction followed by persistent hypersexuality and hemiballism. A lacunar inf arction 1 cm in diameter was observed on magnetic resonance imaging. We hyp othesized that metabolic abnormalities would be detected in cortical areas related to his neurobehavioral symptoms. Background: Statistical validation of the regional metabolic changes that may relate to neuropsychiatric symp toms has been elusive. Relating metabolic changes to neuropsychiatric sympt oms is especially important in unique neurobehavioral cases. Method: Quanti tative fluorodeoxyglucose positron emission tomography was obtained for a s ingle-subject comparison with scans from 60 healthy subjects. Results: Subs tantial glucose hypometabolism (p <0.001, uncorrected; [df = 56]) was ident ified in the subthalamic nucleus at the site of the lacunar infarction. Hyp ermetabolism (p <0.01) was identified within the basal forebrain and tempor al lobes, anterior cingulate and medial prefrontal cortices (areas previous ly associated with hypersexuality), and striatum (p <0.001) ipsilateral to the stroke (areas known to relate to hemiballism). Conclusions: Single-subj ect statistical parametric mapping may improve our understanding of unique neurobehavioral cases.