CASE VIGNETTE
Lionel, a 24-year-old man with Down syndrome, had some rage episodes during adolescence. For the past 4 years, he had exhibited no problems with rage behavior; his life was stable and he was employed at a local factory. He recently sustained a blow to his head, causing him to be unconscious for 18 hours. On awakening at the hospital, his neurological examination showed nonspecific changes. Electroencephalography showed slowing over the temporal areas—unchanged from the tracing made 3 years earlier. Within 48 hours, findings from the patient’s neurological examination were within normal range. A cerebral contusion was diagnosed, and he was discharged.
Two weeks after the accident, one of his parents contacted the discharging neurologist to report that Lionel had experienced several episodes of severe, frenzied rages. The parent commented, “The episodes are kind of like the ones he used to have when he was 15, except they are even more intense and they do not last very long.” The mother, an emergency department nurse, had recorded his blood pressure at 160/90 mm Hg and his pulse rate over 120 beats per minute during one episode.
Question to consider
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