Hypersexuality following bilateral thalamic infarction: case report

Abstract

-Hypersexuality is a rare but well recognized condition following brain injury. It has been described secondarily to dysfunction in the hypothalamus, the temporal and frontal lobes. We re p o rt a 63 y e a r-old man that developed neuropsychological disturbances with hypersexuality as a prominent feature , disinhibition and moderate memory loss, hypersomnia and irritability after a bilateral paramedian thalamic infarction. A SPECT showed frontal hypoperfusion. We believe that these findings are expression of f ro n t a l -s u b c o rtical circuits dysfunction, particularly the orbitofrontal circuit, secondary to dorso medial thalamic infarction which probably plays a role in the determination of human sexual behavior. This case favors a thalamic modulation of frontal function.KEY WORDS: hypersexuality, disinhibition, behavior, paramedian thalamic infarction, fro n t a l -s u b c o rt i c a l circuits.Hiperssexualidade após infarto talâmico bilateral: relato de caso RESUMO -Hiperssexualidade é uma condição rara mas bem reconhecida após lesão do sistema nerv o s o central. A literatura medica registra casos secundários a disfunção do hipotálamo, do lobo temporal e do lobo frontal. Relatamos o caso de um homem de 63 anos de idade que desenvolveu alterações neuropsicológicas com hiperssexualidade como característica mais proeminente, desinibição, moderada perda de memória, hipersonia e irritabilidade após infarto talâmico paramediano bilateral. O SPECT evidenciou hipoperfusão frontal. Nós acreditamos que esses achados sejam expressão da disfunção de circuitos córti-co-subcorticais frontais, particularmente do circuito órbito-frontal, secundária ao infarto dorsomedial do tálamo, que provavelmente desempenha papel relevante na determinação do comportamento sexual humano. Este caso favorece uma possível função moduladora do tálamo sobre os circuitos córt i c o -s u b c o rticais frontais.PA L AV R A S -C H AVE: hipersexualidade, desinibição, comportamento, infarto talâmico paramediano, circ u i t o s córtico-subcorticais.Hypersexuality and alteration of sexual pre f e rence have been recognized as rare consequences of brain injury 1 . Their occurrence provides import a n t clues for understanding the anatomy and physiology of human sexual behavior. Lesions in the stru c t ures such as the amygdala, the hypothalamus, the temporal and frontal lobes have been described in association to these symptoms 1 . Lesion in the frontal lobe has been re f e rred as an anatomical site that pro d u c e s t rue hypersexuality while the other stru c t u res are m o re related to changes of sexual pre f e re n c e 1 , 2 . Fro nt a l -s u b c o rtical circuits are implicated in the determ ination of many aspects of human behavior 3 thus raising the question wether sexuality could be one of them. Such circuits involve several stru c t u res such as striatum, globus pallidus, substance nigra and thalamus. Evidence that fro n t a l -s u b c o rtical circuits mediate a given behavior is provided by the observation that lesions in...

Abrupt onset of disturbed vigilance, bilateral third nerve palsy and masturbating behaviour: a rare presentation of stroke

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Injury and recovery: Severe amnestic syndrome following traumatic brain injury

“…In particular, memory disorders including retrograde and anterograde amnesia are commonly reported [6,[8][9][10][11], as well as aphasia [12,13], frontal disinhibition [14], motor problems [15], severe personality changes [16,17] and hypersexuality [18].…”

Current differential diagnoses and treatment options of vascular occlusions presenting as bilateral thalamic infarcts: a review of the literature

“…Typical long-term conditions include amnesia62 63 65–67 and apathy 62 64 65 68. Other less frequent symptoms of bilateral paramedian thalamic infarctions that have been reported include recurrent episodes of paroxysmal sleep and unresponsiveness,69 70 hypersexuality,71 akinetic mutism72 and eyelid apraxia 73. The symptoms of ‘top of the basilar artery’ syndrome include unusual levels of alertness, sleep-wake cycle, behavior and oculomotor or pupillomotor functions 7.…”