Klüver-Bucy Syndrome After Traumatic Brain Injuries with Bitemporal Cellular Hypoperfusion: Two Cases Reported of Cognitive Recovery

Klüver-Bucy Syndrome (KBS) is a rare combination of signs and symptoms including placidity, psychic blindness, hypersexuality, oral tendency, increased appetite and hypermetamorphosis. It can be secondary to non-traumatic or traumatic causes, mostly severe head trauma, with good prognosis when the patient survives. KBS has been classically described as a disconnection of the temporal lobes from the rest of the brain. However, it can also occur following unilateral left temporal lobe lesions or bifrontobasal regions. Patient 1: 18 years-old man, victim of a car accident, with a history of consciousness loss. He appeared stable at initial evaluation, with a frontal wound, scoring 14 at Glasgow Coma Scale (GCS), without motor deficits. Initial Computed Tomography (CT) scan images showed right temporal and left frontal high-density lesions suggesting gliding contusions. Magnetic Resonance Imaging (MRI) performed 14 days after hospitalization evidenced the same lesions. The brain single-photon emission computed tomography (SPECT) showed bitemporal hypoperfusion. During hospitalization, patient developed psychomotor agitation, hypersexuality (public masturbation) and oral tendencies, and was then diagnosed KBS with neuropsychological assessment. Patient 2: 18 years-old woman, victim of a car accident. At admission, she appeared stable, with an extensive wound in right frontal region. Neurologic examination showed an 11 score at GCS, pupils wisely anisochoric (R > L) and photoreactives (direct right eye trauma), with no motor deficits. The initial cranial CT scan showed diffuse points of high density (bleeding), due to long-term angular acceleration mechanism, suggesting diffuse axonal injury (DAI), and cerebral cortical traumatic meningeal hemorrhage. MRI performed in the 19 day of hospitalization showed diffuse hyperintense points, suggesting diffuse hemorrhagic lesions and visible bilateral uncal lesions. The brain Doppler at the 26 day was normal. Brain SPECT in the 28 days showed bilateral fronto-temporal hypoperfusion. The patient developed improvement of consciousness level and then behavioral disorders. She was submitted to a neuropsychological assessment, that showed euphoric humor, hypersexuality (excessive masturbation), oral tendencies, hypermetamorphosis and hyperbulimia. It was diagnosed post-traumatic KBS.