Kluver-Bucy Syndrome and Minor Head Trauma — Study Notes

Abstract

  • Kluver-Bucy syndrome (KBS) described as a disconnection of the temporal lobes from the rest of the brain.

  • Historically reported mainly with bilateral temporal lobe injury and often in severe head trauma.

  • This report presents what the authors believe to be the first case of KBS due to mild head trauma with unilateral (left) temporal lobe injury and spontaneous resolution.

  • Classic features of KBS include blunted affect, bulimia, hypersexuality, and aggressive behavior, but presentations can vary and may be self-limiting.

Case Report

  • Patient: 24-year-old female highway truck driver involved in a high-speed motor vehicle collision.

  • Initial presentation: stable vital signs, ability to move all extremities; Glasgow Coma Scale (GCS) = 14; laceration on the medial left ankle.

  • Initial workup:

    • CT head, blood tests, urinalysis: largely normal.

    • Blood alcohol concentration: 0.08\%.

  • Hospital course:

    • Ongoing mild depression, excessive somnolence, and blunted affect.

    • Language issues: speech incomprehensible in Korean; attempting to respond in broken English; difficulties finding words.

    • Behavioral changes: increased appetite (voracious eating, often 5–6 meals/day), amnesia for recent items.

    • No loss of consciousness, motor difficulty, or seizures at any point.

    • Language episode details: responses appeared premeditated with limited spontaneity; required concentration to produce speech.

    • Social/behavioral changes: episodes of irritability with staff; running naked around the ward; bizarre behaviors (e.g., moving his/her feet against a physician’s leg); commenting that doctors should be “tall and handsome.”

  • Language and cognition:

    • Korean translator noted responses in broken English; cognitive tasks consistent with language difficulty rather than gross aphasia.

  • Evaluations:

    • Neurologic exam largely normal aside from abnormal behavior.

    • Psychiatric evaluation: depression and obsessive-compulsive features, but no need for psychiatric medication.

    • Repeated CT head: no abnormalities.

    • EEG: no seizures.

  • Imaging findings:

    • MRI performed after other studies: multiple small plaques with increased signal on T2-weighted images in the frontal, temporal, and parietal lobes, resembling demyelination plaques; a single large plaque in the white matter of the left temporal lobe was evident (see Figure). No lesions in the gray matter or the amygdala of the temporal lobes; no overt lesions in the right temporal lobe.

    • Personal and family history negative for demyelinating diseases (e.g., multiple sclerosis).

    • Diagnosis based on clinical presentation and MRI: focal axonal injury to the left temporal lobe.

    • CT and MRI otherwise showed no evidence of hemorrhage or contusion.

  • Course and outcome:

    • Over the next several days, appetite, affect, and irritability gradually improved.

    • Patient’s mood and language improved; smiling and more normal conversational tone returned; appetite normalized over time.

    • By discharge, signs of improvement were evident, and the patient was sent to a rehabilitation facility for continued recovery.

Imaging Findings (Implicated in Diagnosis)

  • MRI findings:

    • Several small plaques on T2-weighted images in frontal, temporal, and parietal lobes; one large lesion in the left temporal lobe white matter.

    • No lesions in gray matter or amygdala; no overt right temporal lobe lesions.

    • Pattern suggested focal axonal injury to the left temporal region rather than a bilateral pattern.

  • CT findings:

    • No acute hemorrhage or contusion.

Neurological and Psychiatric Features Relevant to KBS

  • Classic KBS features (from the literature):

    • Aphasia and amnesia are common in many cases.

    • Blunted affect, apathy, prosopagnosia (psychic blindness), hypermetamorphosis (excessive exploration of surroundings), bulimia, hyperactive oral behaviors, and altered sexual behavior (e.g., increased sexual advances).

  • In this case:

    • Aphasia and amnesia were present alongside blunted affect.

    • Increased oral activity and altered sexual behavior manifested as aggressive, flirtatious remarks toward male physicians.

    • Despite unilateral involvement, some KBS features were observed, aligning with the syndrome’s behavioral phenotype.

Discussion

  • Origin and classic description:

    • In 1937, Kluver and Bucy described a reproducible behavioral syndrome in rhesus monkeys after bilateral temporal lobectomy: oral examination of objects, loss of normal anger and fear responses, increased sexual activity, and impaired recognition of objects (visual agnosia).

    • In humans, KBS was first recognized in 1955 after bilateral temporal lobectomy for refractory seizures, with similar behavioral clusters.

  • Etiology and scope:

    • A wide range of etiologies has been linked to KBS beyond bilateral trauma, including:

    • Temporal lobe epilepsy

    • Herpes simplex temportal encephalitis

    • Alzheimer's disease and Pick’s disease

    • Cerebrovascular disease

    • Metabolic disturbances

    • Multicentric glioblastoma

    • Traumatic brain injury

    • Although KBS is classically associated with bilateral temporal involvement, unilateral temporal lesions (e.g., left temporal lobe) have been reported to produce KBS features as well.

  • Pathophysiology (what seems to cause features):

    • Sensory (visual) recognition and recognition of objects are linked to the temporal neocortex; damage here disrupts sensory recognition.

    • Oral behavior and hypersexuality appear to be connected to disruptions in the amygdala.

    • The syndrome has traditionally been described with bilateral involvement but unilateral cases can occur.

  • Post-traumatic KBS and prognosis:

    • Posttraumatic KBS typically occurs after severe head injury with bilateral temporal involvement and often during recovery/remission phases.

    • Some literature suggests that the presence of KBS after trauma may actually be a positive prognostic indicator for neurologic recovery; the course is usually self-limiting, ranging from about 7 days to 1 year.

    • In nontraumatic cases, various pharmacologic approaches (not universally effective) have been used:

    • Carbamazepine

    • Leuprolide

    • Selective serotonin reuptake inhibitors (SSRIs)

  • Case significance and interpretation:

    • The reported case is notable for:

    • Mild head trauma with a unilateral left temporal lesion, leading to KBS features, which is rare in the literature.

    • A milder initial presentation (GCS = 14) compared with the typical severe trauma (GCS often 3–7) described in other traumatic KBS cases.

    • Spontaneous, self-limited recovery over time, aligning with the self-limiting nature described for traumatic KBS.

  • Clinical implications:

    • Clinicians should consider KBS in patients with new behavioral changes after temporal lobe injury, even with mild trauma and unilateral lesions.

    • The syndrome can be self-limiting; however, follow-up and supportive care (including rehabilitation) are important for functional recovery.

Conclusion

  • Kluver-Bucy syndrome is a rare condition, typically associated with bilateral temporal lobe injury and often seen after severe head trauma.

  • This report documents a unique case of KBS arising from mild head trauma with unilateral left temporal lobe involvement and demonstrates spontaneous resolution.

  • The case supports the concept that KBS can be self-limiting and may be associated with a favorable neurologic prognosis in the traumatic setting.

Key Points

  • Kluver-Bucy syndrome can occur with bilateral temporal lobe injury and presents with blunted affect, bulimia, hypersexuality, and aggressive behavior.

  • The syndrome is often self-limiting and can have a favorable neurologic outcome.

  • Although classically linked to bilateral temporal lesions, unilateral left temporal injury can produce KBS features.

  • In traumatic cases, the natural history may involve recovery over days to months; quick recovery correlates with better prognosis.

  • In this case, a mild GCS score at presentation and unilateral left temporal involvement still yielded the KBS phenotype, which improved spontaneously over the hospital course.

Imaging and Clinical Correlates Summary

  • Clinical: aphasia and amnesia; blunted affect; increased oral activity; abrupt, inappropriate social behaviors (e.g., naked wandering, flirtatious comments to clinicians).

  • Imaging: left temporal lobe white matter lesion with a few accompanying plaques; no amygdala involvement; no bilateral temporal lesions noted; no gray matter lesions.

  • Outcome: gradual clinical improvement and discharge to rehabilitation with ongoing recovery.

References (selected as listed in the article)

  • 1. Kluver H, Bucy P: An analysis of certain effects of bilateral temporal lobectomy in rhesus monkeys, with special reference to psychic blindness. Neurology (referenced in article).

  • 2. Hardy TL, Aldridge J: Traumatic transient Kluver-Bucy syndrome.

  • 3. Kluver H, Bucy P: An analysis of certain effects of bilateral temporal lobectomy in the rhesus monkey, with special reference to psychic blindness. (Additional citation in article.)

  • 4. Kluver-Bucy syndrome in Pick disease: clinical and pathological correlations.

  • 5. Terziin H, Dalle Ore V: Syndrome of Kluver and Bucy reproduced in man by bilateral removal of temporal lobes.

  • 6. Cammings I, Dichen LW: Kluver-Bucy syndrome in Pick disease: clinical and pathological correlations.

  • 7. Ott BR: Leuprolide treatment of sexual aggression in a patient with dementia and the Kluver-Bucy syndrome.

  • 8. Guidnai TL, Dainess MH, Lamon MM: Acute intermittent porphyria and the Kluver-Bucy syndrome.

  • 9. Glinka-Schmid F, Assal G, De Tribolel N, et al: Kluver-Bucy syndrome after left anterior temporal resection.

  1. Gersenksi I, Kwialkowski S, Polak J, et al: The Kluver-Bucy syndrome.

  1. Housliang W, Sepdham T, WiesJK: Kluver-Bucy syndrome: successful treatment with carbamazepine.

  1. Slaughter J, Bobo W, Childers MK: SSRI treatment of post-traumatic Kluver-Bucy syndrome.

  1. Salim, Gerstenbrand F: Presence of Kluver-Bucy syndrome as a positive prognostic feature for the remission of traumatic prolonged disturbances of consciousness.

  • Note: The references above are presented as they appeared in the article; some spellings in the source may be garbled in transcription.

Damage to the temporal lobe can lead to a variety of changes, notably manifesting as Klüver–Bucy syndrome, a condition characterized by reduced fear and anxiety, increased oral explorations of objects, and other abnormal behaviors. Given its crucial role in language and memory, damage can also result in language deficits (aphasia) and various memory impairments. Its intricate connections to regions governing emotion and memory underscore its vital contribution to our overall experience and interaction with the world.

According to Samil, KBS characteristics can appear with unilateral temporal lobe injury and even mild trauma, despite being historically linked to bilateral temporal lobe injury and severe head trauma.

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