87 year-old with delirium after a recent fall




CT noncontrast



CT Noncontrast




Axial FLAIR



Gradient Echo



T1 Axial



T1 sagittal




Findings:

Multiple foci of acute hemorrhage some within bifrontal foci of cystic encephalomalacia.

DDX:

For the chronic bifronal lesions:  trauma, infarct, surgical




Diagnosis:

Frontal lobotomy in this patient with long history of psychiatric disease.


Discussion:

Approximately 40,000 frontal lobotomies were performed in the USA between 1940 and 1970.  There are characteristic symmetric and coronally oriented clefts created in the frontal lobes.



Submitted by Dean Shibata, MD, UW Neuroradiology

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