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Biological Psychiatry Sep 2020
Topics: Akinetic Mutism; Basal Ganglia; Benzodiazepines; Betacoronavirus; COVID-19; Catatonia; Coronavirus Infections; Delirium; Diagnosis, Differential; Electroconvulsive Therapy; History; Humans; Neurobiology; Neuropsychiatry; Pandemics; Patient Care Management; Pneumonia, Viral; SARS-CoV-2; gamma-Aminobutyric Acid
PubMed: 32792053
DOI: 10.1016/j.biopsych.2020.07.001 -
Internal Medicine (Tokyo, Japan) 2012We report a case of a patient with highly active anti-retroviral therapy-resistant human immunodeficiency virus (HIV)-associated progressive multifocal...
We report a case of a patient with highly active anti-retroviral therapy-resistant human immunodeficiency virus (HIV)-associated progressive multifocal leukoencephalopathy (PML). The patient showed an improvement in imaging findings and clinical symptoms after mefloquine was introduced as an additional treatment. Serial assessment of white matter lesions was conducted by proton magnetic resonance spectroscopy ((1)H-MRS) and diffusion-weighted imaging (DWI). As the clinical symptoms improved, the N-acetylaspartate/creatine ratio increased, the choline/creatine ratio decreased, and the elevated ADC value decreased. These concomitant changes suggested that (1)H-MRS and DWI were useful for the assessment of the therapeutic effect on PML.
Topics: Akinetic Mutism; HIV Infections; Humans; Leukoencephalopathy, Progressive Multifocal; Magnetic Resonance Imaging; Male; Mefloquine; Middle Aged; Treatment Outcome
PubMed: 22246492
DOI: 10.2169/internalmedicine.51.6253 -
Neurology Nov 1981
Topics: Adult; Akinetic Mutism; Bromocriptine; Carbidopa; Ergolines; Humans; Hypothalamic Neoplasms; Hypothalamus; Levodopa; Male; Methylphenidate; Postoperative Complications
PubMed: 6118841
DOI: 10.1212/wnl.31.11.1435 -
Neurology Jan 1969
Topics: Aged; Cerebellar Neoplasms; Hemangiosarcoma; Humans; Hydrocephalus; Intracranial Pressure; Male; Memory Disorders; Movement Disorders; Mutism; Speech Disorders
PubMed: 5813125
DOI: 10.1212/wnl.19.1.32 -
Journal of Neurology Jul 2000
Topics: Adult; Akinetic Mutism; Dopamine Agents; Female; Frontal Lobe; Humans; Levodopa; Treatment Outcome
PubMed: 10993505
DOI: 10.1007/s004150070161 -
Progress in Brain Research 2005Clinical observations have established that certain parts of the brain are essential for consciousness whereas other parts are not. For example, different areas of the... (Review)
Review
Clinical observations have established that certain parts of the brain are essential for consciousness whereas other parts are not. For example, different areas of the cerebral cortex contribute different modalities and submodalities of consciousness, whereas the cerebellum does not, despite having even more neurons. It is also well established that consciousness depends on the way the brain functions. For example, consciousness is much reduced during slow wave sleep and generalized seizures, even though the levels of neural activity are comparable or higher than in wakefulness. To understand why this is so, empirical observations on the neural correlates of consciousness need to be complemented by a principled theoretical approach. Otherwise, it is unlikely that we could ever establish to what extent consciousness is present in neurological conditions such as akinetic mutism, psychomotor seizures, or sleepwalking, and to what extent it is present in newborn babies and animals. A principled approach is provided by the information integration theory of consciousness. This theory claims that consciousness corresponds to a system's capacity to integrate information, and proposes a way to measure such capacity. The information integration theory can account for several neurobiological observations concerning consciousness, including: (i) the association of consciousness with certain neural systems rather than with others; (ii) the fact that neural processes underlying consciousness can influence or be influenced by neural processes that remain unconscious; (iii) the reduction of consciousness during dreamless sleep and generalized seizures; and (iv) the time requirements on neural interactions that support consciousness.
Topics: Brain; Consciousness; Humans; Mental Processes; Neurosciences
PubMed: 16186019
DOI: 10.1016/S0079-6123(05)50009-8 -
NeuroRehabilitation 2012Delayed post-hypoxic leukoencephalopathy is a rare condition marked by the development of neuropsychiatric symptoms, parkinsonism and akinetic mutism days to weeks after...
OBJECTIVE/BACKGROUND
Delayed post-hypoxic leukoencephalopathy is a rare condition marked by the development of neuropsychiatric symptoms, parkinsonism and akinetic mutism days to weeks after an individual has recovered from a prolonged cerebral hypoxic event. This syndrome can cause significant long-term neurologic dysfunction. At present there are no acute treatment strategies that have been identified that have been shown to alter the natural course of this disorder. In most instances all that can be offered to patients is early supportive care and then subsequent rehabilitation services.
METHODS
Case Report.
RESULTS
A patient is presented who developed new onset encephalopathy, extrapyramidal symptoms and akinetic mutism three weeks after being discharged for a respiratory arrest from a drug overdose. MRI showed the development of extensive white matter and bilateral globus pallidus lesions. She had rapid resolution of akinetic mutism with intravenous magnesium sulfate as well as improvement in her other associated neurologic symptoms.
CONCLUSION
The case report suggests the use of intravenous magnesium sulfate as an acute treatment for the akinetic mutism associated with delayed post-hypoxic leukoencephalopathy. In addition it also may improve the extrapyramidal and neuropsychiatric symptoms associated with this syndrome. This may be the first potential acute treatment for this rare neurologic condition.
Topics: Akinetic Mutism; Analgesics; Brain; Female; Humans; Hypoxia; Leukoencephalopathies; Magnesium Sulfate; Magnetic Resonance Imaging; Middle Aged
PubMed: 22672948
DOI: 10.3233/NRE-2012-0763 -
BMC Neurology Oct 2023Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its...
BACKGROUND
Creutzfeldt-Jakob disease (CJD) is a rapidly progressive and ultimately fatal neurodegenerative condition caused by prions. The clinical symptoms of CJD vary with its subtype, and may include dementia, visual hallucinations, myoclonus, ataxia, (extra)pyramidal signs and akinetic mutism. In the early course of disease however, several clinical symptoms of CJD may mimic those of co-existing morbidities.
CASE PRESENTATION
We report a male in his 60s with a history of situs inversus totalis and Churg Strauss syndrome, who presented with speech fluency disturbances, neuropsychiatric symptoms and allodynia, a few months after becoming a widower. Initially presumed a bereavement disorder along with a flare-up of Churg Strauss, his symptoms gradually worsened with apraxia, myoclonic jerks and eventually, akinetic mutism. MRI revealed hyperintensities at the caudate nucleus and thalami, while the cerebrospinal fluid was positive for the 14-3-3 protein and the real-time quick test, making the diagnosis of CJD highly probable. This case illustrates the complexities that may arise in diagnosing CJD when pre-existing multimorbidity may cloud the clinical presentation. We also discuss the potential mechanisms underlying the co-occurrence of three rare conditions (situs inversus totalis, Churg Strauss syndrome, CJD) in one patient, taking into consideration the possibility of coincidence as well as common underlying factors.
CONCLUSIONS
The diagnosis of CJD may be easily missed when its clinical symptoms are obscured by those of pre-existing (rare) multimorbidity. This case highlights that when the multimorbidity has neurological manifestations, an extensive evaluation remains crucial to establish the diagnosis, minimize the risk of prion-transmission and provide appropriate guidance to patients and their caregivers.
Topics: Humans; Male; Creutzfeldt-Jakob Syndrome; Akinetic Mutism; Churg-Strauss Syndrome; Multimorbidity; Myoclonus; Situs Inversus
PubMed: 37784069
DOI: 10.1186/s12883-023-03401-5 -
Journal of Neurosurgery Jan 1998
Topics: Child; Equipment Failure; Humans; Hydrocephalus; Hypokinesia; Male; Mutism; Ventriculoperitoneal Shunt
PubMed: 9420094
DOI: 10.3171/jns.1998.88.1.0161 -
European Child & Adolescent Psychiatry Dec 1996A girl aged 9 years with Rasmussen's encephalitis previously treated by left temporal lobectomy suddenly developed prolonged attacks of extremely rapid respirations...
A girl aged 9 years with Rasmussen's encephalitis previously treated by left temporal lobectomy suddenly developed prolonged attacks of extremely rapid respirations associated with poverty of body movements and greatly reduced facial movements with loss of speech. Her comprehension appeared intact and she responded to certain requests. Her eye gaze behaviour suggested a high degree of vigilance. The attacks would last from minutes to hours and were repeated up to a dozen times daily. In the context of the stress generated by the illness and other family problems the attacks had been mistaken for an hysterical elaboration. Their ictal nature was confirmed by EEG/video monitoring. Possible links with other developmental language disorders associated with epilepsy are discussed, including a model of autism.
Topics: Akinetic Mutism; Child; Encephalitis; Epilepsy, Complex Partial; Female; Humans; Postoperative Complications; Syndrome; Temporal Lobe
PubMed: 8989562
DOI: 10.1007/BF00538850