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Revue Neurologique Feb 1975The authors describe three pathological cases of akinetic mutism with, as a common basic lesion, bilateral infarction of the cingulate gyrus secondary to aneurysm of the...
The authors describe three pathological cases of akinetic mutism with, as a common basic lesion, bilateral infarction of the cingulate gyrus secondary to aneurysm of the anterior communicating artery (case n degrees 1), to a huge olfactory meningioma (case n degrees 2), both operated on, and to atheromatous occlusion of the anterior cerebral arterial system (case n degrees 3). These three cases enable a variety of "anterior and waking" akinetic mutism to be described which is unusual enough to be compared with other mesencephalic and diencephalic aspects of this syndrome. It is in fact an akinetic mutism characterized by: a certain dissociation in its non-response to various stimuli, a particularly marked appearance of wakefulness when day-time alertness is considered, conservation of the waking-sleeping rhythm, perception and reaction unpredictable and paradoxical in both degree and quality, complete absence of any spontaneous verbal communication in contrast to relative break-down of solicited communication which is infrequent, uncertain and unresponsive to the usual methods of stimulation, without any possibility of a code. In addition, there is a remarkable mimic and segmental general akinesia, resistant to the usual nociceptive stimuli, but sensitive to slight excitation of the manual and oral zones. Besides this special akinetic mutism, there are variously systematised signs, mostly asymmetrical, indicating lesion of the cortico-sub-cortical frontal structures bordering on the gyrus cinguli. This unusual behaviour pattern corresponds in these three cases to extensive anterior bilateral ischemic lesions of the cingulate gyrus regularly associated with bilateral infarctions confined to the medial aspect of F1 in the superficial territory of the two anterior cerebral arteries, to possible neurosurgical changes (ablation of the right frontal pole) and to compressive or ischaemic lesions of the gyrus rectus. These exclusively cortico-sub-cortical associated lesions are in contrast with the remarkably intact caudate nuclei, the pallidal, thalamic, hypothalamic and septal formations and the anterior pillars of the fornix. These findings compared with the results of experimental research carried out by M. Kennard, help, if help is needed, to resolve the apparent contradictions between the effects of therapeutic cingulectomies or cingulotomies and the scanty pathological data already available in cerebral vascular pathology.
Topics: Adult; Aged; Akinetic Mutism; Arteriosclerosis; Brain; Brain Neoplasms; Cerebral Hemorrhage; Cerebrovascular Disorders; Coma; Corpus Callosum; Female; Gyrus Cinguli; Hemiplegia; Humans; Infarction; Intracranial Aneurysm; Male; Meningioma; Middle Aged; Neurologic Manifestations; Neurosurgery; Olfactory Bulb; Sleep
PubMed: 1135549
DOI: No ID Found -
Journal of Neurology Mar 1992In a patient with akinetic mutism, extensive circumscribed bilateral lesions in the precentral part of the centrum semiovale, due to delayed necrotizing...
In a patient with akinetic mutism, extensive circumscribed bilateral lesions in the precentral part of the centrum semiovale, due to delayed necrotizing leucoencephalopathy after combined intravenous polychemotherapy and radiation, were found at autopsy. CT and somatosensory evoked potentials were normal and a slow alpha rhythm was present, but there was a lack of EEG desynchronization. Akinetic mutism and the loss of desynchronization in this case are thought to result from interrupted thalamofrontal and extrathalamic reticulofrontal projections and the disconnection of the anterior limbic cortex.
Topics: Adult; Afferent Pathways; Akinetic Mutism; Alpha Rhythm; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Breast Neoplasms; Chemotherapy, Adjuvant; Combined Modality Therapy; Cranial Fossa, Posterior; Cranial Irradiation; Cyclophosphamide; Demyelinating Diseases; Doxorubicin; Electroencephalography; Evoked Potentials, Somatosensory; Female; Fluorouracil; Humans; Mastectomy; Methotrexate; Necrosis; Stereotyped Behavior
PubMed: 1573414
DOI: 10.1007/BF00833909 -
Frontiers of Neurology and Neuroscience 2012Anterior cerebral artery (ACA) territory strokes account for 0.5-3% of all ischemic strokes. The etiological mechanisms of ACA territory strokes vary by race; ACA... (Review)
Review
Anterior cerebral artery (ACA) territory strokes account for 0.5-3% of all ischemic strokes. The etiological mechanisms of ACA territory strokes vary by race; ACA dissection is a frequent cause in Japan. The most prevalent symptom of such strokes is contralateral hemiparesis or monoparesis, usually affecting the leg predominantly. Predominant leg weakness is attributed to damage in the paracentral lobule, and weakness of the arm and face is associated with involvement of Heubner's artery and the medial striate arteries. Hypobulia, typically 'akinetic mutism', is also common. Several behavioral disorders, including the grasp reflex and the alien hand sign, can present as callosal disconnection signs. Transcortical aphasia and urinary incontinence are other frequent symptoms. A non-throbbing headache is common at stroke onset in patients with ACA dissection.
Topics: Humans; Infarction, Anterior Cerebral Artery
PubMed: 22377877
DOI: 10.1159/000333607 -
The Journal of Neuropsychiatry and... 2003
Topics: Adult; Akinetic Mutism; Cerebral Arterial Diseases; Functional Laterality; Gyrus Cinguli; Humans; Magnetic Resonance Imaging; Male; Recovery of Function
PubMed: 12928521
DOI: 10.1176/jnp.15.3.385 -
Journal of Neurology, Neurosurgery, and... Apr 1988
Topics: Aged; Akinetic Mutism; Alcohol Amnestic Disorder; Atrophy; Brain; Female; Humans; Tomography, X-Ray Computed; Wernicke Encephalopathy
PubMed: 3379437
DOI: 10.1136/jnnp.51.4.588 -
Neuropatologia Polska 1974
Topics: Adult; Akinetic Mutism; Autopsy; Female; Hepatolenticular Degeneration; Humans; Pons; Thalamus
PubMed: 4850472
DOI: No ID Found -
The Journal of Neuropsychiatry and... 1995A 25-year-old woman with multiple sclerosis and an affective disorder probably secondary to MS presented with multiple neurological signs and symptoms suggestive of...
A 25-year-old woman with multiple sclerosis and an affective disorder probably secondary to MS presented with multiple neurological signs and symptoms suggestive of active MS, most prominently akinetic mutism. Spinal fluid analysis and MRI supported a diagnosis of active MS. SPECT and EEG were nonspecifically abnormal. After 6 weeks of severe akinetic mutism refractory to one ECT treatment and trials of steroids and stimulants, the patient recovered spontaneously over a 2-month period. An acute brainstem lesion seen on MRI may explain this patient's akinetic mutism.
Topics: Adult; Akinetic Mutism; Brain; Electroencephalography; Female; Humans; Magnetic Resonance Imaging; Multiple Sclerosis; Neuropsychological Tests; Tomography, Emission-Computed, Single-Photon
PubMed: 7711499
DOI: 10.1176/jnp.7.1.90 -
Journal of Clinical Neuroscience :... Jun 2005Intracranial lipomas are rare benign congenital neoplasms accounting for 0.1 to 0.5% of all primary brain tumours. Approximately 50% are associated with other cerebral...
Intracranial lipomas are rare benign congenital neoplasms accounting for 0.1 to 0.5% of all primary brain tumours. Approximately 50% are associated with other cerebral developmental disorders. These slow growing benign lesions are usually asymptomatic and rarely require surgery. We report the case of a 37 year old woman presented with signs of raised intracranial pressure. Computerized tomography and magnetic resonance imaging demonstrated a quadrigeminal cistern lipoma compressing the aqueduct of Sylvius. The patient underwent surgery and a distinct plane of cleavage between the lipoma and the adjacent neural structures was found, allowing total removal of the lesion. Postoperatively, the patient was relieved of her original symptoms but developed akinetic mutism which lasted for two weeks. Intracranial lipomas rarely become symptomatic and surgery is seldom required. If the lesion progresses and causes symptoms of raised intracranial pressure or compression of neural structures, surgical intervention is indicated. Total removal should not be attempted unless a plain of cleavage between the lesion and adjacent neural structures is present. Surgical manipulation should be minimised to avoid complications.
Topics: Adult; Akinetic Mutism; Brain; Brain Neoplasms; Cerebellum; Corpus Callosum; Decompression, Surgical; Endoscopy; Female; Headache; Humans; Intracranial Hypertension; Lipoma; Magnetic Resonance Imaging; Neurosurgical Procedures; Subarachnoid Space; Tectum Mesencephali; Tomography, X-Ray Computed; Treatment Outcome; Vomiting
PubMed: 15936197
DOI: 10.1016/j.jocn.2004.08.015 -
The Journal of Neuropsychiatry and... 1999Akinetic mutism is characterized by alertness with near complete absence of volitional activity. The authors report a case of episodically remitting akinetic mutism...
Akinetic mutism is characterized by alertness with near complete absence of volitional activity. The authors report a case of episodically remitting akinetic mutism following subarachnoid hemorrhage.
Topics: Catatonia; Chronic Disease; Diagnosis, Differential; Disease Progression; Humans; Hypokinesia; Male; Middle Aged; Mutism; Seizures; Sleep Stages; Subarachnoid Hemorrhage
PubMed: 9990564
DOI: 10.1176/jnp.11.1.100 -
Archives of Neurology Apr 1987We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body...
Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study.
We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A trial of high-dose bromocriptine did not stimulate purposeful verbal or motor activity. Fluorine 18-fluorodeoxyglucose/positron emission tomographic studies, performed before and during bromocriptine therapy, demonstrated cerebral hypometabolism and treatment-related decreases in regional cerebral blood volume. We conclude that whole-brain or total-body irradiation may increase blood-brain barrier permeability to polyene antibiotics, and that high-dose therapy with dopamine agonists is unlikely to benefit patients with akinetic mutism due to diffuse white-matter lesions.
Topics: Adult; Akinetic Mutism; Amphotericin B; Anemia, Aplastic; Bone Marrow Transplantation; Bromocriptine; Cerebrovascular Circulation; Deoxyglucose; Fluorodeoxyglucose F18; Glucose; Humans; Male; Tomography, Emission-Computed; Whole-Body Irradiation
PubMed: 3548667
DOI: 10.1001/archneur.1987.00520160048013