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Neuropsychological Rehabilitation Mar 2018Following a description about the characteristics of akinetic mutism (AM) and how it differs from locked-in syndrome (LIS) and a disorder of consciousness (DOC), we...
Following a description about the characteristics of akinetic mutism (AM) and how it differs from locked-in syndrome (LIS) and a disorder of consciousness (DOC), we present the case of David, a 71-year-old man with AM. David sustained a stroke following a middle cerebral artery (MCA) thrombus. A CT scan at the time detected old ischaemic infarcts affecting the right frontal lobe, the left occipital lobe and the left parietal lobe so David had bilateral brain damage. Initially thought to have a DOC, further neuropsychological assessments administered when David had improved a little, resulted in the diagnosis of AM. Although David spoke little, when he did speak, his words and phrases were well articulated, grammatical and with appropriate intonation. He was alert and visually aware and he was not paralysed. We discuss whether the diagnosis was correct and address the difficulties in assessing such patients.
Topics: Aged; Akinetic Mutism; Humans; Male; Neuropsychological Tests; Stroke
PubMed: 28150524
DOI: 10.1080/09602011.2017.1281147 -
Journal of Clinical Neuroscience :... Jan 2004This is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. The diagnosis is important as akinetic mutism is...
This is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. The diagnosis is important as akinetic mutism is often misdiagnosed as depression, delirium and locked-in-syndrome. This is a descriptive study of eight selected patients with akinetic mutism following infarction/haemorrhage in different regions of the brain with characteristic syndromes. They involved the critical areas namely, the frontal (cingulate gyrus, supplementary motor area and dorso-lateral border zone), basal ganglia (caudate, putamen), the mesencephalon and thalamus. The disorders of speech and communication took different forms. The speech disorder included verbal inertia, hypophonia, perseveration, softened and at times slurred. The linguistic disturbances were fluent, non-fluent, anomia and transcortical (motor, mixed) aphasias. The findings were related to what is known about the neuroanatomic location of the lesions and the role of the frontal-subcortical circuitry in relation to behaviour. Akinetic mutism could be explained by damage to the frontal lobe and or interruption of the complex frontal subcortical circuits.
Topics: Adult; Aged; Akinetic Mutism; Brain; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neurologic Examination; Stroke; Tomography, X-Ray Computed
PubMed: 14642361
DOI: 10.1016/j.jocn.2003.04.002 -
A&A Practice Jul 2023Differential diagnosis of the underlying cause of new-onset total body paralysis can be challenging and unsatisfying. In akinetic mutism, a rare side effect of...
Differential diagnosis of the underlying cause of new-onset total body paralysis can be challenging and unsatisfying. In akinetic mutism, a rare side effect of tacrolimus, patients become apathetic, mute, and lose voluntary muscle movement. Epidural subarachnoid migration can present with similar symptoms. Delayed emergence/paralysis after anesthesia can include the common culprits of residual operative medications, stroke, as well as tacrolimus-induced akinetic mutism and thoracic epidural migration. We present a case of new-onset total body paralysis, presenting on postoperative day 1 following a double-lung transplant in a patient started on tacrolimus with a thoracic epidural catheter in place.
Topics: Humans; Tacrolimus; Akinetic Mutism; Anesthesia, Epidural; Paralysis; Catheters
PubMed: 37463290
DOI: 10.1213/XAA.0000000000001699 -
The American Journal of Emergency... Apr 2017We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare...
We describe a 44-year-old man who developed akinetic mutism following a cerebrovascular accident involving his left middle cerebral artery. We discuss this rare condition and its unusual clinical picture.
Topics: Adult; Akinetic Mutism; Atrial Fibrillation; Bundle-Branch Block; Echocardiography; Humans; Hypertension, Pulmonary; Infarction, Middle Cerebral Artery; Male; Mitral Valve Stenosis; Stroke Volume; Tomography, X-Ray Computed
PubMed: 27955795
DOI: 10.1016/j.ajem.2016.11.008 -
Cerebral Palsy Bulletin 1960
Topics: Akinetic Mutism; Brain; Brain Diseases; Brain Neoplasms; Deafness; Humans; Speech Disorders
PubMed: 13749007
DOI: No ID Found -
Arquivos de Neuro-psiquiatria Sep 1956
Topics: Akinetic Mutism; Cerebellopontine Angle; Cerebellum; Humans; Medical Records; Movement Disorders; Neoplasms; Neurilemmoma; Rhabdomyosarcoma; Speech Disorders
PubMed: 13373630
DOI: 10.1590/s0004-282x1956000300002 -
Neuropathology : Official Journal of... Apr 2017This review will explore the clinical and pathological findings of the various forms of Creutzfeldt-Jakob disease (CJD). Clinical findings of CJD are characterized by... (Review)
Review
This review will explore the clinical and pathological findings of the various forms of Creutzfeldt-Jakob disease (CJD). Clinical findings of CJD are characterized by rapidly progressive cognitive dysfunction, diffusion-weighted magnetic resonance imaging (DWI) hyperintensity, myoclonus, periodic sharp-wave complexes on electroencephalogram and akinetic mutism state. Neuropathologic findings of CJD are characterized by spongiform changes in gray matter, gliosis-particularly hypertrophic astrocytosis-neuropil rarefaction, neuron loss and prion protein (PrP) deposition. The earliest pathological symptom observed by HE staining in the cerebral cortex is spongiform change. This spongiform change begins several months before clinical onset, and is followed by gliosis. Subsequently, neuropil rarefaction appears, followed by neuron loss. Regions showing fine vacuole-type spongiform change reflect synaptic-type PrP deposition and type 1 PrP deposition, whereas regions showing large confluent vacuole-type spongiform changes reflect perivacuolar-type PrP deposition and type 2 PrP deposition. Hyperintensities of the cerebral gray matter observed in DWI indicate the pathology of the spongiform change in CJD. The cerebral cortical lesions with large confluent vacuoles and type 2 PrP show higher brightness and more continuous hyperintensity on DWI than those with fine vacuoles and type 1 PrP . CJD cases showing diffuse myelin pallor of cerebral white matter have been described as panencephalopathic-type, and this white matter pathology is mainly due to secondary degeneration caused by cerebral cortical involvement, particularly in regard to neuron loss. In conclusion, clinical and neuroimaging findings and neuropathologic observations are well matched in both typical and atypical cases in CJD. The clinical diagnosis of CJD is relatively easy for typical CJD cases such as the MM1-type. However, even in atypical cases it seems that clinical findings can be used for an accurate diagnosis.
Topics: Adult; Aged; Aged, 80 and over; Akinetic Mutism; Brain; Creutzfeldt-Jakob Syndrome; Disease Progression; Female; Humans; Male; Middle Aged; Myoclonus; Neuroimaging
PubMed: 28028861
DOI: 10.1111/neup.12355 -
WMJ : Official Publication of the State... Oct 2022COVID-19 has been associated with neurological complications, including encephalopathy and akinetic mutism.
INTRODUCTION
COVID-19 has been associated with neurological complications, including encephalopathy and akinetic mutism.
CASE PRESENTATION
A 7-year-old unvaccinated boy presented with visual hallucinations, urinary incontinence, and akinetic mutism 13 days after he was exposed to COVID-19. He had minimal respiratory symptoms, including just 1 day of fever and cough. Evaluations showed slowing on electroencephalogram, normal cerebrospinal fluid, normal brain magnetic resonance imaging, and mild sinus bradycardia. He recovered rapidly to baseline after 5 days of intravenous methylprednisolone.
DISCUSSION
COVID-19-related encephalopathy including akinetic mutism is usually found in older adult patients with more severe COVID-19 illness. Our case demonstrates that akinetic mutism can present in children with mild COVID-19 illness and that it can respond rapidly and completely to intravenous methylprednisolone.
CONCLUSIONS
COVID-19-related encephalopathy may be immune mediated. A heightened awareness of its association with COVID-19 illness should lead to earlier diagnosis and consideration of immunomodulatory therapy.
Topics: Male; Child; Humans; Aged; Akinetic Mutism; COVID-19; Magnetic Resonance Imaging; Methylprednisolone
PubMed: 36301657
DOI: No ID Found -
Journal of Neurology, Neurosurgery, and... Apr 1998Among the classification criteria for the diagnosis of Creutzfeldt-Jakob disease, akinetic mutism is described as a symptom which helps to establish the diagnosis as...
OBJECTIVES
Among the classification criteria for the diagnosis of Creutzfeldt-Jakob disease, akinetic mutism is described as a symptom which helps to establish the diagnosis as possible or probable. Akinetic mutism has been anatomically divided into two forms--the mesencephalic form and the frontal form. The aim of this study was to delimit the symptom of akinetic mutism in patients with Creutzfeldt-Jakob disease from the complex of symptoms of an apallic syndrome and to assign it to the individual forms.
METHODS
Between April and December 1996, 25 akinetic and mute patients with Creutzfeldt-Jakob disease were consecutively examined. The patients were classified according to the definition of akinetic mutism by Cairns and secondly in accordance with the features constituting the complete picture of an appalic syndrome (defined by Gerstenbrand).
RESULTS
From 25 patients with definite Creutzfeldt-Jakob disease, 24 patients showed impoverishment of speech and, after a mean duration of four (range 1.1-11.2) months, almost complete absence of voluntary movements and speech. Seven patients were classified as being mute and akinetic and assigned to the mesencephalic form whereas 13 patients were classified as apallic. One patient was mute without being akinetic and four patients were comatose.
CONCLUSION
Diffuse brain damage underlies akinetic mutism in patients with Creutzfeldt-Jakob disease. The term can be used as a classification criterion for the diagnosis of Creutzfeldt-Jakob disease; however, it should be applied very carefully and delimited clearly from the apallic syndrome.
Topics: Adult; Aged; Aged, 80 and over; Akinetic Mutism; Consciousness; Creutzfeldt-Jakob Syndrome; Female; Fixation, Ocular; Frontal Lobe; Humans; Male; Mesencephalon; Middle Aged; Motor Activity; Neurologic Examination
PubMed: 9576547
DOI: 10.1136/jnnp.64.4.524 -
The American Journal of Psychiatry Nov 1962
Topics: Akinetic Mutism; Catatonia; Humans; Schizophrenia, Catatonic; Speech Disorders
PubMed: 13978428
DOI: 10.1176/ajp.119.5.451