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Hypersexuality from resection of left occipital arteriovenous malformation

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Abstract

The authors report their experience on one patient with hypersexuality from resection of left occipital arteriovenous malformation. To the best of our knowledge, this is the first case reported in the literature. A 35-year-old right-handed female farmer suffered a sudden left occipital hemorrhage with subarachnoid and subdural hemorrhages of the left hemisphere. Transient left uncal herniation occurred at the onset and was released by conservative treatment. Digital subtraction angiography showed a brain left occipital arteriovenous malformation. After microsurgical resection of the arteriovenous malformation, the patient developed hypersexual behavior. Positron emission tomography showed hypermetabolism in the left frontal region and left posterior hippocampal gyrus and hypometabolism in the left anterior hippocampal gyrus and the left occipital surgical area. Theories concerning normal pressure perfusion breakthrough and specific areas in the brain responsible for the human sexual response are discussed.

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Authors and Affiliations

  1. Department of Neurosurgery, Beijing Tiantan Hospital, affiliated to Capital Medical University, 6 Tiantan Xili, Chongwen District, Beijing, 100050, China

    Yong Cao, Rong Wang, Shuo Wang & Jizong Zhao

  2. PET Center, Peking Union Medical College Hospital, 1 Shuaifuyuan Wangfujing, Beijing, 100730, China

    Zhaohui Zhu

Authors
  1. Yong Cao
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  2. Zhaohui Zhu
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  3. Rong Wang
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  4. Shuo Wang
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  5. Jizong Zhao
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Corresponding author

Correspondence to Jizong Zhao.

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Comments

Liu-Guan Bian, Shanghai, China

The authors reported an interesting rare case: one patient with hypersexuality from resection of left occipital AVM. The authors suggested that there was an uncal herniation before the surgery, which might have injury to the left uncus and hippocamp of temporal lobe. Secondly, this hypersexuality might be associated with NPPB. These were demonstrated by positron emission tomography (PET), which showed hypermetabolism in the left frontal region and left posterior hippocampal gyrus and hypometabolism in the left anterior hippocampal gyrus. However, Tosto et al. reported hypersexuality in an Alzheimer’s disease case. A 18-FDG PET scan evidenced prevalent hypometabolism of the right hemisphere [1]. Furthermore, the hypersexuality and cerebrovascular disease, including aneurysm and stroke, was also reported by Ozdemi and Rees. respectively [2, 3]. Additionally, different brain systems may play a role in this disorder. Frontal lesions may be accompanied by disinhibition, including impulsive hypersexual response to external cues, while striatal lesions may be accompanied by repetitive triggering of internally generated response patterns. Temporal-limbic lesions may be accompanied by disturbances in sexual appetite itself, including change in the direction of sexual drive [4].

References

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2 Ozdemir H, Rezaki M. Klüver-Bucy-like syndrome and frontal symptoms following cerebrovascular disease Turk Psikiyatri Derg. 2007;18(2):184–8.

3. Rees PM, Fowler CJ, Maas CP. Sexual function in men and women with neurological disorders. Lancet. 2007;369(9560):512–25.

4. Stein DJ, Hugo F, Oosthuizen P, Hawkridge SM, van Heerden B. Neuropsychiatry of hypersexuality. CNS Spectr. 2000 Jan;5(1):36–46.

Comments

Tetsuya Goto, Matsumoto, Japan

The authors described a patient with hypersexuality after resection of an occipital hemorrhagic AVM. Her pre- and postoperative course is interesting. Although they concluded that her postoperative hypersexuality was caused not only by uncal herniation but also by NPPB, it is still difficult to understand that resection of a small occipital AVM caused NPPB at the temporal and frontal lobes, which persisted more than 3 months.

The author’s hypothesis, i.e., her postoperative hypersexuality was caused by resection of the nidus, seems reasonable only when her preoperative neurological status was normal because uncal herniation itself can cause hypersexuality. The preoperative MRI showed midline shift not recovered yet. If the patient demonstrated hypersexuality with her conscious being alert, hemodynamic changes may be contributing.

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Cao, Y., Zhu, Z., Wang, R. et al. Hypersexuality from resection of left occipital arteriovenous malformation. Neurosurg Rev 33, 107–114 (2010). https://doi.org/10.1007/s10143-009-0232-2

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  • DOI: https://doi.org/10.1007/s10143-009-0232-2

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