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Figure 6–6. Late subacute presentation of traumatic brain injury.

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Figure 6–6. Late subacute presentation of traumatic brain injury.A 24-year-old man had a motor vehicle accident with no loss of consciousness 10 years after a mild head injury. Shortly thereafter, the patient presented with severe cognitive deficits, depression, agitation, aggression, and psychosis. Symptoms were sufficiently severe to require prolonged psychiatric hospitalization. MR examination during this time was normal. Numerous perfusion abnormalities were evident on SPECT scans acquired 2 years later (a single sagittal and three coronal sections are illustrated). The most pronounced abnormality was moderately reduced perfusion in the left parietal lobe near the posterior Sylvian fissure and in both temporal lobes. Mildly reduced perfusion was noted in the occipital lobes (left greater than right) and basal ganglia (particularly near the caudate heads). Some of these abnormalities are visible on both the sagittal and coronal images (arrows). MR = magnetic resonance; SPECT = single-photon emission computed tomography.

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