Precuneus and psychiatric manifestations: Novel neurobiological formulations through lesion based connectivity mapping of psychopathology

•Contribution of brain lesions to psychiatric symptoms is poorly understood.•Lesion-based functional connectivity mapping in a patient with left precuneus granuloma was attempted.•Normative functional connectome open-source data was used for the brain lesion mapping.•Kinetopsia and delusions could be explained based on lesion-based correlated and anti-correlated brain networks. Lesion-based investigations of psychopathology have preceded contemporary network-neuroscience initiatives. However, brain-lesions detected in routine psychiatric practice are often considered incidental and therefore ignored. Here, we illustrate a strategy to combine individual subject-level lesion information with open-source normative functional-connectomics data to make putative, neuroscience-informed symptom interpretation. Specifically, we report a patient with left precuneus granulomatous lesion and seizures followed by two distinct symptoms – kinetopsia and delusions of nihilism and guilt – which had a differential treatment response. The lesion-based brain-mapping approach could identify correlated (default-mode) and anti-correlated (temporo-parieto-occipital) networks, which enabled a neurobiological formulation of these diverse clinical manifestations.