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Kluver-Bucy syndrome in traumatic brain injury: A case study
406
Abstracts of 16th Annual Meeting
with the deterioration of some aspects of neuropsychological functioning, particularly those functions thought to be subserved by the frontal and medial temporal cortex.
Smigielski, J. S., & Boeve, B. E Kluver-Bucy Syndrome in Traumatic Brain Injury: A Case Study. We present a case study of an individual who demonstrated a Kluver-Bucy syndrome in the context of severe traumatic brain injury. The patient, a 25-year-old Caucasian female injured in a motorcycle accident, sustained bilateral temporal lobe hemorrhagic contusions in addition to bi-frontal injury. She underwent a left temporal lobectomy shortly after injury. When evaluated after transfer to an inpatient rehabilitation unit, she demonstrated prominent symptoms of a Kluver-Bucy syndrome, including hyperorality, hypersexuality, and hypervigilance with hypermetamorphosis. Other symptoms included physical and verbal aggression, agitation and disorientation, presumed to be associated with frontal and diffuse cerebral injury in addition to bilateral temporal dysfunction. Severe deficits in global cognitive functioning were observed initially, with gradual improvement noted over several weeks. Deficits in memory remained prominent on mental status exam up to the time of dismissal home, approximately 2 months after injury. Included in this presentation are neuroimaging data (CT, MRI, and SPECT), EEG findings, results of serial administrations of the GOAT (Galveston Orientation and Amnesia Test), and findings of repeat behavioral neurology evaluations. Results of neuropsychological evaluation conducted as part of a comprehensive follow-up rehabilitation assessment are also included. Though Kluver-Bucy syndrome is frequently considered chronic and irreversible, this patient demonstrated impressive neurocognitive and neurobehavioral recovery. Findings of follow-up assessments conducted 8 to 1 months after injury are reviewed, including particular focus upon the patient's substantial gains in memory functioning despite extensive bi-temporal injury. The significance of the diagnosis of Kluver-Bucy syndrome for understanding this patient, and providing a rationale for treatment of problematic behaviors, especially early in the rehabilitation course, is discussed. Smith, S. S. Comparison of the Utility of Two Short Forms of the Wisconsin Card Sorting Test in Acute Traumatic Brain Injury. Two short forms of the Wisconsin Card Sorting Test (WCST), 64-card (WCST-64) and 3-category (WCST-3) versions, have been investigated as alternatives to the standard 128card administration of the WCST for schizophrenic, epileptic, and Alzheimer's dementia subjects. The research has suggested that the WCST-64 is an acceptable alternative to the full WCST, whereas the WCST-3 correlations with the full WCST were low and underestimated the number of perseverative responses. The purpose of this study was to compare these short forms for use with acute traumatic brain injury (TBI) subjects, as these individuals often demonstrate damage to the frontal lobes due to the orbitofrontal region's proximity to the sphenoid wing, as well as diffuse axonal shearing. One-hundred twenty-seven acute TBI subjects were recruited from among consecutive inpatient referrals to the neuropsychology service of a trauma center. Each patient was administered the full WCST as part of an assessment of their cognitive functioning. The WCST protocols were then rescored to obtain WCST-64 and WCST-3 scores. Pearson product-moment correlations between the WCST and WCST-3 ranged from .65 to .75. WCST-64 correlations with the full WCST were generally higher, ranging from .81 to .93. Based on full WCST performance, from 50.4 to 69.3% of the subjects fell within the impaired range for number of categories completed, perseverative responses, and errors when compared to the standard norms. For the WCST-3, using previously published projected cutoff scores, 27.4% of the subjects fell within the impaired
Abstracts of 16th Annual Meeting
with the deterioration of some aspects of neuropsychological functioning, particularly those functions thought to be subserved by the frontal and medial temporal cortex.
Smigielski, J. S., & Boeve, B. E Kluver-Bucy Syndrome in Traumatic Brain Injury: A Case Study. We present a case study of an individual who demonstrated a Kluver-Bucy syndrome in the context of severe traumatic brain injury. The patient, a 25-year-old Caucasian female injured in a motorcycle accident, sustained bilateral temporal lobe hemorrhagic contusions in addition to bi-frontal injury. She underwent a left temporal lobectomy shortly after injury. When evaluated after transfer to an inpatient rehabilitation unit, she demonstrated prominent symptoms of a Kluver-Bucy syndrome, including hyperorality, hypersexuality, and hypervigilance with hypermetamorphosis. Other symptoms included physical and verbal aggression, agitation and disorientation, presumed to be associated with frontal and diffuse cerebral injury in addition to bilateral temporal dysfunction. Severe deficits in global cognitive functioning were observed initially, with gradual improvement noted over several weeks. Deficits in memory remained prominent on mental status exam up to the time of dismissal home, approximately 2 months after injury. Included in this presentation are neuroimaging data (CT, MRI, and SPECT), EEG findings, results of serial administrations of the GOAT (Galveston Orientation and Amnesia Test), and findings of repeat behavioral neurology evaluations. Results of neuropsychological evaluation conducted as part of a comprehensive follow-up rehabilitation assessment are also included. Though Kluver-Bucy syndrome is frequently considered chronic and irreversible, this patient demonstrated impressive neurocognitive and neurobehavioral recovery. Findings of follow-up assessments conducted 8 to 1 months after injury are reviewed, including particular focus upon the patient's substantial gains in memory functioning despite extensive bi-temporal injury. The significance of the diagnosis of Kluver-Bucy syndrome for understanding this patient, and providing a rationale for treatment of problematic behaviors, especially early in the rehabilitation course, is discussed. Smith, S. S. Comparison of the Utility of Two Short Forms of the Wisconsin Card Sorting Test in Acute Traumatic Brain Injury. Two short forms of the Wisconsin Card Sorting Test (WCST), 64-card (WCST-64) and 3-category (WCST-3) versions, have been investigated as alternatives to the standard 128card administration of the WCST for schizophrenic, epileptic, and Alzheimer's dementia subjects. The research has suggested that the WCST-64 is an acceptable alternative to the full WCST, whereas the WCST-3 correlations with the full WCST were low and underestimated the number of perseverative responses. The purpose of this study was to compare these short forms for use with acute traumatic brain injury (TBI) subjects, as these individuals often demonstrate damage to the frontal lobes due to the orbitofrontal region's proximity to the sphenoid wing, as well as diffuse axonal shearing. One-hundred twenty-seven acute TBI subjects were recruited from among consecutive inpatient referrals to the neuropsychology service of a trauma center. Each patient was administered the full WCST as part of an assessment of their cognitive functioning. The WCST protocols were then rescored to obtain WCST-64 and WCST-3 scores. Pearson product-moment correlations between the WCST and WCST-3 ranged from .65 to .75. WCST-64 correlations with the full WCST were generally higher, ranging from .81 to .93. Based on full WCST performance, from 50.4 to 69.3% of the subjects fell within the impaired range for number of categories completed, perseverative responses, and errors when compared to the standard norms. For the WCST-3, using previously published projected cutoff scores, 27.4% of the subjects fell within the impaired