Title: Post traumatic brain injury - organic personality change with fronto-temporal gliosis- Case Report

INTRODUCTION: Personality change in post Traumatic Brain Injury occurs in 59.1% of patients.(1)It can present with symptoms of depression, emotional instability, irritability and impulsive behaviour. (2)`Personality changes might not be obvious during the initial period of injury as the sensory and motor deficits will be predominant (3). CASE HISTORY: A 26 year old male with a history of Road traffic accident in 2014 with ensuing severe traumatic brain injury with Right Temporoparietal Subdural hemorrhage and midline shift, conservatively managed. Intial year following the TBI, he had retrograde and antegrade amnesia and needed support for his activities of daily living. Gradually his behavioural changes emerged.The patient had significant social and functional impairment at the time of admission (1-08-2021)and the family sought treatment. EXAMINATION: Higher mental functions-Impairment in delayed recall, abstract and social judgement.Lobar Function tests revealed impairment in abstract, lexical fluency suggestive of frontal damage and impaired recall and verbal memory with emotional and behavioural changes and placidity suggestive of temporal damage. DIAGNOSIS: A diagnosis of F 07.0 ORGANIC PERSONALITY DISORDER according to ICD-10 was made. MRI BRAIN revealed Gliosis in frontal and temporal lobes, Chronic lacunae in posterior Periventricular region, Mild Periventricular deep white matter hyperintensities. He was managed with Haloperidol, sodium valproate and benzodiazepines. CONCLUSION: Post traumatic brain injury organic personality change is a neurobehavioural sequelae of severe TBI. It has considerable overlap with several psychiatric and neurological disorders. Serial follow-up is necessary to evaluate the evolution of deficits and prognosis.