Neurological cases of child sexual abuse (acquired pedophilia) are sometimes used as evidence for the neuroanatomical bases of pedophilia. However, these cases seem to represent a more general syndrome of impulsivity or hypersexuality than a true modification of sexual interests. Therefore, acquired pedophilia may not be adequate to investigate the neurological correlates of pedophilia. The main goal of this study was to systematically review cases of acquired pedophilia to explore the possibility that they are more closely associated with generalized behavioral impulsivity or hyperactivity than a late onset sexual interest toward children. Following the Preferred Reporting Items for SysteMAtic reviews (PRISMA) guidelines, 64 cases of acquired pedophilia were identified. All but one were men. As expected, the mean age of onset for acquired pedophilic behaviors was higher than 50-year-old (M = 52.8-y.-o., SD = 15.6), most cases committed various additional sexual and nonsexual impulsive acts, and only a minority (19%) showed premorbid pedophilic interests. Brain damage mostly involved basal fronto-temporal regions associated with sexual, but also impulsive behaviors. It is concluded that acquired pedophilia should not be used as evidence for the neurological bases of genuine pedophilia. Psychiatric diagnoses of pedophilic disorder would also benefit from adding an exclusion criterion based on neurological etiology. Future investigations are required to determine why acquired pedophilia is almost exclusively observed in men.