Everyone desires of elevated happiness. But elevated happiness at the expense of head shot is quite queer.
A man of age 63 years was presented for medical attention. He had history of frontotemporal brain injury and a craniotomy. He had been a prisoner for 23 years as he had charge of murder against him. According to him, a voice inside his head commanded him to commit suicide. He didn’t commit suicide instead he murdered a man. As soon as the police arrived, there was exchange of bullets between them and the man. During encounter, police shot him in his head. He was taken to hospital for immediate treatment and fortunately, he recovered. That incident changed his personality completely.
Before that event, he was a depressed individual who had suicidal thoughts. Later, he had elevated happiness and a carefree attitude with no worries and anxiety. He had a history of being treated for seizures with divalproex and lacosamide. After the trauma to his head, his right eye blinded. Moreover, he called himself a blabtist instead of Baptist because all he could do was blab.
From being suicidal to a cheerful person
Physical and neurological examination revealed clear signs of gun shot. A depression was also visible due to the craniotomy conducted. He had right eye ptosis and proptosis and right facial paralysis. His motor examination was normal, including bilateral tone and strength.
During his examination, he appeared very relaxed. His abnormally elevated happiness caused him no concerns about whatever was going around him. He kept the staff engaged by passing funny comments and making jokes. Since he had undergone craniotomy therefore he performed Valsalva to make the site of craniotomy prominent. This would amuse him and the staff. He kept the environment cheery. When the examination was still going on he asked a staff member a silly question which was “Do you want to hear a dirty joke?” and then he answered it himself after few seconds by saying “A white horse fell in the mud.” As a part of examination, the doctors asked him to not joke for a while. Surprisingly, he did control his fun-making episode and stayed calm without any trace of anxiety or unhappiness. His teasing comments and silly jokes reflected that he didn’t take the situation seriously.
As long as his speech was concerned, it was perfectly normal. There was no hesitation, stammering or withdrawal in mid-sentence. He was very well aware of his surroundings but he couldn’t judge the seriousness. His body language was also normal as he made eye contact, took turns in speaking and had good social understanding. He pronounced the words properly. His grammar and sentence structure was also correct. The rate of speaking words was also normal; not too fast and not too slow. His speech was not dysarthric. Interestingly, he was aware about his cognitive problems.
MRI Results
Computerized tomography and magnetic resonance imaging (MRI) of the head showed extensive volume loss and gliosis of the right frontal lobe, the right anterior temporal lobe, and the left orbitofrontal region.
The damage to the right frontal and right anterior temporal lobes changed the personality of this man completely. Elevated happiness at the expense of head injury made him extremely positive and satisfied without being concerned about the situation he was in. He could not only joke but also detect and understand jokes to which he replied in same manner.
