Sexual assault by a gynecologist with two frontal lobe meningiomas: implications and challenges for forensic psychiatric assessment: a case report

Brain diseases may determine the development of focal neurological deficits and behavioral anomalies. In some cases, behavioral alterations may lead to illicit demeanours which, in turn, may have potential serious legal consequences as well. We report the case of a male gynecologist in his seventies sued by a young female patient for sexual violence. The man had no significant premorbid medical history and was a respected medical doctor with several decades of professional activity. Months after the sexual violence episode, he began to manifest symptoms indicative of cognitive impairment, which led to a neurological examination including a Magnetic Resonance Imaging (MRI) brain scan exam. Brain MRI revealed two frontal meningiomas with mass effects and vasogenic oedema on the surrounding brain parenchyma, for which the patient underwent a neurosurgical operation. Following surgery, partial improvement in selected cognitive and behavioral domains was observed, suggesting that the frontal lesions may have contributed significantly, though not exclusively, to the clinical picture. In light of this evidence, the question arises whether and to what extent the mental capacity of the subject at the time of sexual offense could have been compromised by the presence and location of the tumors, that is, as a potential “precipitating factor” impinging on a brain with underlying neurodegenerative and/or vascular lesions.