Resident Physician Emory Decatur, Georgia, United States
Case Diagnosis: This is a case of Kluver-Bucy Syndrome (KBS) arising from a traumatic brain injury (TBI) with bitemporal subdural (SDH) and subarachnoid hemorrhage (SAH). KBS is a rare neurobehavioral condition resulting from temporal lobe lesions and characterized by placidity (loss of anger and fear), visual agnosia, hypersexuality, hyperorality, and hypermetamorphosis (the propensity to react or touch every visual stimulus).
Case Description: A 27-year-old male was brought to a level 1 trauma center following ejection from a moving vehicle, rendering him unresponsive with a Glasgow Coma Scale of 5 on initial evaluation. A non-contrast head CT revealed multicompartment hemorrhages, including acute bilateral frontotemporal SDH with mid-line shift and SAH.
He exhibited hyperphagia/hyper-orality (consuming non-food items such as clothing, restraints, and feces), and hypersexuality through inappropriate remarks and aggressive behaviors to staff. Short-term memory deficits necessitated frequent reorientation, and his affect was noticeably blunted.
Initial treatment included Amantadine 100 mg twice daily (BID), quetiapine titrated up to 200 mg three times daily (TID), and use of anti-psychotics like olanzapine and ziprasidone as needed. After a few weeks without much improvement, he was started on Depakote 250 mg TID. Amantadine was discontinued due to concerns about its contribution to symptoms. With Depakote and the discontinuation of Amantadine, behavioral improvements were observed.
Discussions: This case demonstrates KBS resulting from TBI with bitemporal intracranial hemorrhages. While cognitive and behavioral manifestations can be severe, they may improve over time with appropriate management using anti-epileptics and anti-psychotics.
Conclusions: KBS can develop following a TBI with bilateral temporal lobe involvement. Clinicians who suspect KBS in patients meeting clinical criteria should promptly initiate appropriate management, emphasizing symptom/behavior control and safety measures. Further studies are needed to elucidate the pathophysiology of this disease to help guide effective treatments.
