Human Kluver-Bucy syndrome following acute subdural haematoma

Abstract

We present a rare case of complete human Kluver-Bucy syndrome (KBS) following recovery from transtentorial herniation caused by acute subdural haematoma (ASDH). A 17-year-old right-handed high school boy got into stupor within five minutes after 3-rounds of sparing at boxing. Emergency computed tomographic (CT) scan showed right cerebral hemispheric ASDH, which was evacuated following intentional decompressive craniectomy. After recovery of consciousness, he developed emotional changes (placidity with loss of normal fear and anger), psychic blindness, aberrant sexual behaviour, excessive oral tendencies, increased appetite, and hypermetamorphosis in order of mention, which were observed with waxing and waning from 17th to 28th hospital day. Peri-operative CT scaning and magnetic resonance imaging showed lesions of the right temporal lobe and right-dominant orbitofrontal regions including bilateral rectal and medial orbital gyri, and the intact left temporal lobe. Two pathogeneses can be thought of and the whole picture of KBS following ASDH can arise even though one (left in this case) temporal lobe is preserved, 1) in which associated orbitofrontal lesions of the frontal lobes may correlate with occurrence of KBS, or 2) cerebral blood hypoperfusion of both temporal lobes due to increased intracranial pressure and/or compression of both posterior cerebral arteries at the edge of the tentorium cerebelli occurs.

Traumatic acute subdural hematoma and coma: retrospective cohort of surgically treated patients

“…[ 3 ] In some patients, cerebral hypoperfusion resulting from intracranial hypertension can lead to cerebral ischemia, more frequently in hemorrhages of the posterior fossa, where the posterior cerebral arteries are vulnerable to compression along the edge of the cerebellar tentorium. [ 23 ]…”

Akut Posterior Fossa Subdural Hematom

“…This is especially true in the posterior fossa, where the posterior cerebral arteries are vulnerable to compression along the free edge of the tentorium cerebelli [15][16][17] . In the absence of head trauma, most patients are usually clinically diagnosed with intracerebellar or subarachnoid hemorrhage and the correct diagnosis is not entertained until a cranial CT scan (and/or MRI) is done.…”

“…Cerebral hypoperfusion due to raised intracranial pressure or the mass effect itself may terminate in cerebral infarction. This is especially true in the posterior fossa, where the posterior cerebral arteries are vulnerable to compression along the free edge of the tentorium cerebelli [15][16][17] .…”

Kluver-Bucy Syndrome Following Herpes Simplex Encephalitis

“…Herpes simplex encephalitis (HSE), Pick's disease, Alzheimer's disease, cerebrovascular disease, head trauma, anoxic-ischemic encephalopathy, epilepsy, juvenile neuronal lipofuscinosis, Huntington's disease, acute intermittent porphyria, tuberculous meningitis, toxoplasmosis, and shigellosis are counted as the causes of KBS (4,5). The common pathology of these causes is bilateral destruction or dysfunction of mesial temporal lobes, but there are case reports showing that unilateral damage (left temporal lobectomy or damage of the right amygdala) can also cause similar symptoms (6,7). We report a patient who presented with KBS following HSE, which is rare.…”