Klüver-Bucy syndrome after left anterior temporal resection

doi:10.1016/0028-3932(94)00097-9

Neuropsychologia

Volume 33, Issue 1, January 1995, Pages 101-113

https://doi.org/10.1016/0028-3932(94)00097-9 Get rights and content

Abstract

A 70-year-old right-handed woman developed a complete Klüver-Bucy syndrome including psychic blindness, aberrant sexual behavior, hypermetamorphosis, aphasia and visual agnosia following left anterior temporal lobectomy for an anaplasic oligodendroglioma. MRI showed no argument for a contralateral ischemic infarct, tumoral growth or white matter damage. Thus the possibility that a unilateral anterior temporal lesion can cause the whole picture of Klüver-Bucy syndrome must therefore be considered.

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Citation Excerpt :
Less commonly, brain injury that produces an irritative lesion, i.e., a damaged area that abnormally disinhibits or stimulates surrounding tissue, has been reported to be associated with abnormal sexuality, as are some cases of frontal and temporal lobe damage, especially when the impairment involves subcortical structures in the limbic system of the brain, as often occurs with temporal lobe epilepsy. The resulting symptoms and behaviors have included hypersexuality, fetishism, and transvestism (Absher et al., 2000; Casanova, Buxhoeveden, & Brown, 2002; Cummings & Mendez, 1984; Davies & Morgenstern, 1960; Dewhurst, Oliver, & McKnight, 1970; Epstein, 1961; Ghika-Scmidt, Assai, De Tribolet, & Regli, 1995; Gorman & Cummings, 1992; Hoenig & Kenna, 1979; Hunter, Logue, & McMenemy, 1963; Kolarski, Fruend, Machek, & Polak, 1967; Lang, 1993; Marlowe, Mancall, & Thomas, 1975; Mendez, Chow, Ringman, Twitchell, & Hinken, 2000; Mendez, O'Connor, & Lim, 2004; Miller, 1993; Miller, 1994a, 1994b; Mitchell, Falconer, & Hill, 1954; Walinder, 1965). However, complicating these interpretations is the specificity problem.
Children are the quintessential innocent victims; therefore, special opprobrium is reserved for offenders who sexually abuse them. This article describes the more prominent typologies of pedophilic sex offenders and discusses the role of child pornography in child sexual abuse of actual children. It next examines the often overlooked population of women offenders who sexually abuse children. Attention then turns to the sexual abuse of children in child care settings and by members of the clergy; practical recommendations are provided for reducing the risk of this kind of institutional child sexual abuse. Theoretical conceptualizations of child sexual abuse are considered, in the three main categories of cognitive–psychodynamic theories, neuropsychological conceptualizations, and contributions from the emerging field of evolutionary psychology. Finally, recommendations are made for developing a way of handling sex offenders, including sexual offenders against children, that balances the fair administration of justice with society's obligation to protect vulnerable potential victims.
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For instance, hyperorality is often observed in frontotemporal dementia and dementia involving hippocampal sclerosis (Pasquier et al., 1999), whereas hypersexuality may occur in patients with temporal lobe epilepsy or after neurosurgery (Blumer, 1970; Ozmen et al., 2004). According to Ghika-Schmid et al. (1995), KBS can also be the result of a unilateral lesion of the dominant temporal lobe. However, herpes encephalitis is the most frequently reported etiology of KBS (Jha and Patel, 2004).
The Klüver–Bucy syndrome (KBS) is characterized by a number of peculiar behavioral symptoms. The syndrome was first observed in 1939 by Heinrich Klüver and Paul Bucy in the rhesus monkey following removal of the greater portion of the monkey's temporal lobes and rhinencephalon. The animal showed (a) visual agnosia (inability to recognize objects without general loss of visual discrimination), (b) excessive oral tendency (oral exploration of objects), (c) hypermetamorphosis (excessive visual attentiveness), (d) placidity with loss of normal fear and anger responses, (e) altered sexual behavior manifesting mainly as marked and indiscriminate hypersexuality, and (f) changes in eating behavior. In humans, KBS can be complete or incomplete. It occurs as a consequence of neurological disorders that essentially cause destruction or dysfunction of bilateral mesial temporal lobe structures (i.e., Pick disease, Alzheimer disease, cerebral trauma, cerebrovascular accidents, temporal lobe epilepsy, herpetic encephalopathy, heat stroke). As for epilepsy, complete and incomplete KBS are well documented in temporal lobe epilepsy, temporal lobectomy, and partial status epilepticus. KBS can occur at any age. Children seem to show similar symptoms to adults, although some differences in the manifestations of symptoms may be related to the fact that children have not yet learned certain behaviors.
Agressive behavior after traumatic brain injury
2011, Annals of Physical and Rehabilitation Medicine
Citation Excerpt :
One of the symptoms of this syndrome is generally a placid behavior, yet some explosive, violent behaviors have sometimes been reported [19]. Anatomically, bitemporal brain injury is the most common type of TBI for this syndrome, but some unilateral lesion [15] and subdural hematoma [43] were also reported. In this case, the temporal lobectomy is unilateral but associated to other brain lesions and temporal extradural hematoma.
In cases of agitation and aggressive behavior after severe traumatic brain injury (TBI), the benefits/risks ratio of pharmacological treatments remains unclear. A qualitative analysis of clinical situations could highlight the relevance of psychotherapy care.
In January 2005, this 24-year-old patient sustained severe traumatic brain injury (Glasgow at 4/15), with bilateral frontotemporal injury and temporal extradural hematoma. On the third day, a temporal lobectomy was performed. The patient's evolution showed severe neurobehavioral disorders, with agitation and aggressive behavior towards family members and medical caregivers. Maximum doses of antipsychotic drugs brought no improvement. Antidepressant medication improved social contact. Several stays in the psychiatric unit, where institutionalized and psychotherapy care were implemented, showed systematically a real improvement of the behavioral disorders, increased participation in group activities and the ability to walk around alone in a closed environment.
Aggressive behavior can unveil organic brain injuries, depressive syndrome as well as iatrogenic nature of the environment. This clinical case is based on the fact that antipsychotic drugs, aside from their sedative effect, are not the proper treatment for agitation following traumatic brain injury. This case also highlights how management of behavioral disorders following TBI should not be based on pharmacological treatments only but instead should focus on multidisciplinary strategies of care.
Dans les cas d’agitation et d’agressivité secondaire à un traumatisme crânien (TC) grave, le rapport bénéfice/risques des traitements médicamenteux est discuté. L’analyse qualitative de situations cliniques peut permettre de dégager l’efficacité de prises en charge psychothérapeutiques.
Un patient de 24 ans présente en janvier 2005 un TC grave (Glasgow 4/15) avec des lésions intraparenchymateuses frontotemporales bilatérales et un hématome extradural temporal gauche. À j3 une lobectomie temporale droite est réalisée. L’évolution est marquée par des troubles du comportement majeurs avec des gestes hétéroagressifs envers les soignants et la famille. Les troubles deviennent tels qu’il doit être maintenu dans sa chambre en dehors des activités de rééducation et des visites. Les neuroleptiques à posologie maximale sont inefficaces. Un antidépresseur permet une amélioration du contact. Plusieurs hospitalisations en psychiatrie, où une prise en charge institutionnelle et psychothérapique est mise en place, montrent systématiquement une amélioration nette des troubles du comportement, une possibilité de participation à des activités de groupe et de déambulation libre dans un espace fermé.
L’agressivité peut traduire les lésions cérébrales organiques, un syndrome dépressif, ainsi que le caractère iatrogène de l’environnement. Ce cas clinique appuie le fait que les neuroleptiques, en dehors de leur effet de sédation, ne sont pas un traitement efficace de l’agitation après TC. Il permet de mettre en évidence combien la prise en charge des troubles du comportement relève surtout de stratégies autres que médicamenteuses et est à la frontière avec d’autres spécialités.
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With a multiple case report analysis we demonstrate that hypersexuality more often results from right hemisphere (RH) (n = 26) than left hemisphere (LH) (n = 7) lesions, possibly because of LH release after the RH lesion, and that ictal orgasm more often occurs in patients with right-sided (n = 23) than left-sided (n = 8) seizure foci, with the symptom probably resulting from RH activation. The LH may be specialized for increasing sexual tension, whereas the RH may be specialized for release of this tension (orgasm), the former being catabolic and the latter anabolic. Several other interpretations of the findings are also discussed.
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Citation Excerpt :
Second, hypersexual behavior can occur with strokes, surgical resections, or other lesions of the temporal lobe, especially on the right [37-41]. Hypersexuality is part of the Klüver‐Bucy syndrome from bilateral anterior temporal‐amygdalar disease [37,40-45], and heightened or altered sexual behavior occurs in right temporal variant patients with FTD [46]. Third, investigators describe patients who manifested hypersexuality from lesions or dysfunction affecting the non‐motor basal ganglia, including pallidotomies and the effects of dopamine agonists [19,47].
Child molestation or other pedophilic behavior may result as a consequence of a brain disorder.
To characterize the mechanisms of pedophilic behavior associated with neurological diseases.
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All eight developed sexual behavior toward prepubescent children in mid‐ to late‐life coincident with the development of a neurological disorder. Five had limited insight, anxiety, or concern for their behavior and tended to have frontal lobe executive deficits. Most of this group had frontally predominant disorders. Two others retained insight and concern in the context of marked hypersexuality. This second group had treated Parkinson's disease and resembled reports of pedophilic behavior from subcortical lesions. The further presence of right temporal lobe‐amygdala involvement may have predisposed to specific sexual preoccupation in some patients.
Brain disorders may release a predisposition to sexual attraction for children through disinhibition with frontal disease, sexual preoccupation with right temporal disease, or hypersexuality with subcortical disease in non‐motor basal ganglia, hypothalamus, or septal nuclei. Differentiating these mechanisms of pedophilic behavior from brain disease could facilitate targeted interventions. Mendez M and Shapira JS. Pedophilic behavior from brain disease.

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Klüver-Bucy syndrome after left anterior temporal resection

Abstract

Neuropsychologia

Cognition

Trends Neurosci.

Neurosci. Biobehav. Rev.

Brain Res.

Cortex

Batterie des Examens Neuropsychologiques du CHUV

Post-traumatic deficit syndromes

Schweiz. Arch. Neurol. Psychiatr.

Syndrome de Klüver-Bucy complet après encephalite à herpès virus complex type II

Rev. Neurol.

Psychiatric phenomena in Alzheimer's disease—IV: Disorders of behaviour

Br. J. Psychiat.

Lasting consequences of bilateral medial temporal lobectomy: Clinical course and experimental findings in HM

Semin. Neurol.

Klüver-Bucy syndrome in Pick's disease: Clinical and pathologic correlations

Neurology

Disorders of visual recognition

Behavioral syndromes in Alzheimer's disease

Int. Psychogeriatr.

Klüver-Bucy syndrome in Pick's disease [letter]

Neurology

Changes in the visual gnostic functions and emotional behaviour following unilateral temporal pole damage in the “split-brain” monkey

Nature

Loss of memory for people following temporal lobe damage

Brain

Disconnections syndromes in animals and man

Brain

Focal epilepsy of the psychomotor type

A preliminary report of observations on effects of surgical therapy

J. Neurosurg.

Acute intermittent porphyria and the Klüver-Bucy syndrome

J. Hopkins Med. J.

Aspects linguistiques des troubles de la vigilance au cours des lésions temporales antérointernes droite et gauche

Neuropsychologia