Multimodal PET, Diffusion Tensor Imaging, and Quantitative MRI Volumetrics Findings in a Forensic Homicide Case Report with Neurobiological Abnormalities Consistent with Hypoxic Brain Injury and Severe Early Childhood Abuse

Background/Objectives: Hypoxic brain damage and adverse childhood experiences (ACEs) are strongly associated with neurodevelopmental disorders, adverse behavioral outcomes, and increased risk of bipolar disorder. This case study evaluates the neurological sequelae of severe childhood trauma and recurrent hypoxia in a man in his mid-20s with a history of extreme violent criminal and sexual behavior, with the aim of clarifying the neurological factors associated with his actions. Methods: Multimodal neuroimaging was performed in a subject with recurrent childhood strangulation-induced hypoxia and sexual, physical, and emotional abuse. Assessments included positron emission tomography (PET) with Z-mapping for metabolic analysis, diffusion tensor imaging (DTI) for white matter integrity, and magnetic resonance imaging (MRI) quantitative volumetrics (QV) for structural evaluation. Results: PET revealed hypometabolism in the left temporal insular cortex and left dorsal posterior cingulate gyrus, a decreased neocortical-to-cerebellar metabolic ratio, and hypermetabolism in the right temporal cortex. DTI showed profound decreases in fractional anisotropy (FA) in the anterior corpus callosum consistent with hypoxic injury. DTI also showed decreased FA in left dorsal anterior cingulate consistent with adverse childhood events. MRI QV demonstrated bilateral putamen enlargement, consistent with multiple hypoxic episodes and bipolar disorder, as well as significant asymmetry, with the left putamen smaller than the right, suggesting relative left–right putamen asymmetry that may be secondary to traumatic brain injury. Conclusions: Multimodal neuroimaging identified marked metabolic, white matter, and volumetric abnormalities consistent with severe childhood hypoxia, childhood abuse, bipolar disorder, and traumatic brain injury. Objective abnormalities in networks involved in impulse control and aggression provide neurobiological context relevant to mitigation considerations in aberrant homicidal behavior.