Electroconvulsive therapy in a middle-aged adult with cortical atrophy.

A 48-year-old male with treated hypothyroidism presented with a long-standing history of depression that had been refractory to treatment. A computed tomography scan of the brain revealed atrophy in the frontal regions. This finding is significant because the patient has no known history of traumatic brain injury, inhalant or alcohol abuse, or prolonged exposure to gasoline. On the basis of the results of the brain imaging in conjunction with the patient's clinical presentation and neuropsychological testing, frontotemporal dementia was considered in the diagnosis and was thought to explain his chronic symptoms of apathy, anhedonia, and suicidal ideation. Electroconvulsive therapy was implemented, with resolution of the patient's depressed mood and neurovegetative symptoms of depression as well as improvement in his Mini Mental Status Examination scores.