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Introduction Frontal lobe lesions are associated with a range of behavioral and cognitive changes that vary according to location, extent, depth and laterality of the lesion. Behavior disturbances are usually divided into positive (related to disinhibition) and negative (related to apathy), while cognitive deficits mainly involve prefrontal functions, including executive functions and social cognition. Case Report In 2009, a 42-year-old man was admitted to the Emergency Department with a cerebrospinal fluid (CSF) rhinorrhea, 2 days after elective endonasal sinus surgery. The fistula was surgically corrected. Three years later, he developed frontal epileptic seizures. A CT scan was performed and revealed multiple right frontobasal cysts and bifrontal inflammation with extensive edema. In 2013, he underwent surgical drainage of the cysts and repair of the anterior cranial fossa. Family members reported that his personality had changed progressively over the 5 years since the endonasal intervention, and he had become reckless, impulsive, sexually disinhibited and aggressive towards his family, showing lack of insight and difficulty in accepting his limitations. He became unable to manage his finances or carry tasks like paying bills, dealing with paperwork and keeping important documents. He also started consuming large amounts of alcohol, which worsened his epilepsy. Because of these behaviors, he was referred to a Psychiatric consultation, where he started medication and underwent a neuropsychological evaluation. Conclusions This case demonstrates the neuropsychiatric changes associated with a frontal lobe syndrome, and the clinical manifestations of frontal lobe epilepsy. Moreover, it encourages the reflection that no surgery is risk-free.

Sotos syndrome, also known as cerebral gigantism, was first described by Juan Sotos in 1964 in five patients with prenatal and postnatal overgrowth, characteristic facial appearance, advanced bone age and developmental delay. Some patients have serious clinical manifestations, such as congenital heart defects, dysplastic kidneys, severe mental retardation and leukemia. A wide spectrum of emotional, cognitive, and behavioral difficulties occur in patients with Sotos syndrome, who have a high risk of developing attention deficit disorder, hyperactivity disorder, and temper tantrums. Other cases have been described in which affected children have feeding and sleeping problems, phobias, and irritability. Many Sotos syndrome children exhibit adaptive problems in social functioning, and some present autistic features. In this study authors present a 30-year-old woman with Sotos syndrome and behavioural difficulties. The patient had Sotos syndrome diagnosed at childhood, with typical facial gestalt, macrocephaly, advanced bone age, scoliosis, kidney abnormalities, pulmonary chronic disease and migraine. At the age of 26 she developed irritability with marked impulsivity, episodes of agressivity and later of self-harm (skin-picking). She was treated with atypical anti-psychotics with positive clinical response. Clinical and laboratory examinations should be performed to prevent and manage any unusual medical aspect of the syndrome. Facial gestalt and macrocephaly, rather than advanced bone age, are the strongest indications for clinical diagnosis.

Sexual effects of medical conditions are commonly multifactorial, involving physiological mechanisms interacting with psychological processes. Thus, to an organic component directly caused by the disease or its treatments, it adds the psychological impact of the illness, namely the associated emotional disturbances and the changes in sexual autoconcept or in couple dynamic. Between chronic patients, the sexual dysfunctions (DS) occur most often in those who present major emotional disturbances, possibly due to the influence of the sexual problem in mood and self-esteem. The typical multifactorial character of DS in general is still more obvious in diabetic patients. Some of the disease directly related factors are Diabetes type and duration, serum HbA1C levels, co-morbid conditions and pharmacological treatment. From the extensive published literature, highlights an obvious dichotomy between the differential influence of organic and psychological factors. Although most of the studies focus on diabetic men erectile dysfunction (ED), the organic risk factors, the few investigations upon diabetic women underline the importance of psychological factors and psychiatric co-morbidity. Overall, there is a focus on the genitality, disregarding the search of other kinds of sexual pleasure. Authors present a brief review about literature published on this theme, pointing out results dissimilarity and differential correlation between related factors associated with DS in diabetics from both sexes.

Notwithstanding the curiosity that it raises in the psychiatric community, the Charles Bonnet Syndrome is still an entity of poor defined contexts, especially in what concerns to its therapeutic management. It consists in complex visual hallucinations in visually impaired patients that possess insight into the unreality of their visual experiences and have no past history of major psychiatric disturbances or cognitive impairment. This syndrome is sub-diagnosed and, perhaps for that, is considered rare. The prevalence of complex visual hallucinations in patients with diminished visual acuity varies between 0,4 and 15%; reports from different authors point to an average of around 10%. The most consensual theory about the origin of the hallucinations is that they result from a process of de-afferentation of the visual association areas of the cerebral cortex, leading to a phenomenon called “phantom vision”.The present communication focus on the clinical case of a 65 years-old women, retired, divorced, socially isolated, with no previous major psychiatric disturbances or cognitive impairment. Her visual deficits resulted from complications of severe myopia. In the past year, she has started with visual complex hallucinations, in the form of people, animals and scenes, without special personal meaning. The patient lives this phenomenon with severe distress.Neuroimaging study failed to find any abnormality. Treatment started with risperidone, carbamazepine and psychotherapy based on reassurance and counselling, to witch there was partial response.The authors emphasize particular clinical aspects and management of this case and present main data published in literature about Charles Bonnet Syndrome.