Abstract
Neuroimaging data can provide valuable insights into insanity evaluations, but the debate over its use for legal purposes is far from resolved. While much attention has been given to the risks of over-interpretation, potential errors stemming from under-interpretation received less scrutiny. In this paper, we aim to showcase how this error may influence the results of an insanity evaluation by presenting an Italian forensic case. The defendant presented with intellectual disability and psychotic symptoms coupled with multiple brain abnormalities that were interpreted as variant of normal neuroanatomy. The case is discussed in detail. This article offers an insight into a neglected issue in forensic neuroscience, destined to gain prominence as this discipline becomes increasingly important in criminal justice systems worldwide. We recommend the use of a multidisciplinary approach to insanity to reduce the likelihood of error. In this context, neuroimaging can play an important role, and its interpretation should strictly adhere to guidelines to minimize the possibility of both over-interpretation and under-interpretation.