Klüver‐Bucy syndrome due to stroke in the left temporal lobe

Abstract

AbstractBackgroundKlüver‐Bucy syndrome (KBS) comprises: 1) hyperorality, 2) hypermetamorphosis, 3) hypersexuality, 4) eating disorder, 5) placidity, 6) visual agnosia (psychic blindness) and 7) amnesia (at least three components are described as partial KBS). The classic description involves bilateral injuries to the anterior temporal lobes, but it has been reported that unilateral lesions can also lead to KBS.MethodCase report and analyses of MR Images (T1, Flair and Tractography) of a patient presenting partial KBS due to stroke in the left temporal lobe.ResultMale patient, 69 years‐old, with cognitive deficits that have begun after a left frontotemporal stroke in 2003, with remarkable changes in the temporal pole. In the first months after the stroke, he used to get lost when out of home and had difficulty remembering names and recognizing well known persons due to psychic blindness. During the next years, the patient developed impairment in declarative memory, but preserved visuospatial skills (many times coming to the medical appointments alone, using public transportation). Over time, he developed binge eating (once eating 1 kilogram of cheese, for instance), inability to deal with money (unnecessary loans in banks) and bizarre sexual behavior (such as excessive addiction to porn movies, public masturbation, flirting with women in his neighborhood, and an episode of inappropriate sexual behavior with his daughter‐in‐law). The patient still resists taking bath and changing clothes.ConclusionThe exact anatomic basis of KBS is still controversial. What is remarkable is the main role of the amygdala in the syndrome. However, periamygdalar lesions can cause disconnection syndromes and damage the limbic network that involves the uncus, the hippocampus, the insular cortex, orbitofrontal and cingulate gyri. Patients with KBS can mimic behavioral variant frontotemporal lobar degeneration (bvFTLD) – particularly regarding eating and sexual disorders, probably due to the connections between the amygdala and the orbitofrontal gyri. The integrity of these two regions and their connections probably play an important role in emotional continence, modulating basic desires in the human species. Lesions in the uncinate fasciculus can predispose to KBS. Our patient exhibits lack of fibers connecting temporal lobe and orbitofrontal cortex showed in the tractography.