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Akinetic Mutism


Presentation

  • Abstract Three cases of bilateral anterior cerebral artery occlusion are presented with akinetic mutism.[ncbi.nlm.nih.gov]
  • At present there are no acute treatment strategies that have been identified that have been shown to alter the natural course of this disorder.[doi.org]
Hyperthermia
  • One day after the dose of atomoxetine was increased from 40 mg/d to 60 mg/d, the patient developed inducible clonus, rigidity, diarrhea, tachycardia, and hyperthermia, in keeping with a diagnosis of SS.[ncbi.nlm.nih.gov]
Hypersomnia
  • We believe that the ‘ptosis’ documented by ED physicians was in fact a combination of hypersomnia with vertical gaze palsy.[academic.oup.com]
Overeating
  • 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.[ncbi.nlm.nih.gov]
  • Movement Disorders collects over 90 of the most memorable and challenging movement disorder cases from the worldís leading authorities in this specialty.[books.google.ro]
  • Over the next 2 days, the patient became more verbal but was confused, agitated, and delusional, with visual and auditory hallucinations.[journals.lww.com]
Palmomental Reflex
  • The primitive motor patterns can be divided into different groups according to the functional basis—for instance, the motor patterns of the oral sense (sucking-chewing automatisms), the grasping reflexes, and the mental reflexes (palmomental reflex).[doi.org]
Gait Apraxia
  • He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction.[ncbi.nlm.nih.gov]
  • At 14 months, he was found to have only mild residual weakness on the right, but maintained significant gait apraxia [ 24 ].[hoajonline.com]

Workup

Periodic Lateralized Epileptiform Discharges
  • Electroencephalography, 24h after admission, showed bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) in the frontal region and diffuse theta and polymorphic delta activity.[ncbi.nlm.nih.gov]

Treatment

  • There is no generally accepted treatment, and it is not known if late treatments are effective. The relationship between AKM and abulia is uncertain.[ncbi.nlm.nih.gov]
  • This may be the first potential acute treatment for this rare neurologic condition.[doi.org]

Prognosis

  • The literature is reviewed, the possible pathophysiological mechanism of akinetic mutism is considered and the association between these two conditions is explored with an attempt to address the roles of medical treatment and surgery and to discuss prognosis[ncbi.nlm.nih.gov]
  • Locked-in syndrome: improvement in the prognosis after an early intensive multidisciplinary rehabilitation . Arch Phys Med Rehabil 2003 ; 84 : 862 –7. 53. Childs NL , Mercer WN , Childs HW. Accuracy of diagnosis of persistent vegetative state .[cambridge.org]
  • The prognosis of the condition is often poor as in our patient and seems independent of the presence or absence of ‘frontal lobe syndrome’ symptomatology [ 3 , 6 ].[academic.oup.com]
  • The prognosis of hypoglycemic encephalopathy depends on co morbidities, associated medical complications, early recognition and treatment, extent of neuroimaging findings and its reversibility.[ijcasereportsandimages.com]

Etiology

  • Cerebrovascular diseases are the most frequent etiology. It has been reported in cyclosporine-related neurotoxicity, but it is exceptional as the presenting form of tacrolimus intoxication.[ncbi.nlm.nih.gov]
  • […] metabolism Humans Male Middle Aged Norepinephrine Plasma Membrane Transport Proteins/antagonists & inhibitors Occipital Lobe/drug effects/metabolism/radionuclide imaging Positron-Emission Tomography Propylamines/therapeutic use Subarachnoid Hemorrhage/etiology[analyzedirect.com]
  • Change of Cerebral Ventricles Kyoung-Soo Lee "Department of Neurology, Gyeongsang National University College of Medicine Gyeongsang Institute of Health Science, Gyeongsang National University" Abstract "Akinetic mutism is a syndrome caused by various etiologies[jkna.org]
  • […] thalamofrontal disconnection: a distinctive movement disorder , Mov Disord , 1997 , vol. 12 (pg. 378 - 85 ) 2 Die perseveration , Ueber Storungen des Handelns bei Gerhirnkranken , 1905 Berlin Karger (pg. 115 - 27 ) 3 Bilateral thalamic infarction: clinical, etiological[academic.oup.com]

Epidemiology

  • Key features include: * New chapters on epidemiology, neuropathology, and genetics of TBI* A new chapter on TBI in the military emphasizing the unique feature of blast injury* A new chapter on posttraumatic stress disorder (PTSD), which emphasizes the[books.google.de]
  • Apart from medical history and a physical examination, a standardised epidemiological questionnaire was completed with the relatives of the patient containing questions about a detailed history.[doi.org]
Sex distribution
Age distribution

Pathophysiology

  • The literature is reviewed, the possible pathophysiological mechanism of akinetic mutism is considered and the association between these two conditions is explored with an attempt to address the roles of medical treatment and surgery and to discuss prognosis[ncbi.nlm.nih.gov]
  • Gain fresh perspectives and up-to-date insights from the world’s leading authorities on the pathophysiology, diagnosis, and management of stroke.[books.google.ro]

Prevention

  • Muromonab-CD3 (OKT3), a mouse monoclonal antibody directed against human T lymphocytes, is a potent immunosuppressive agent used to reverse and more recently to prevent allograft rejection, mostly in cardiac transplant recipients.[ncbi.nlm.nih.gov]
  • Stay up to date on hot topics such as mechanisms of action of commonly used drugs, neuronal angiogenesis and stem cells, basic mechanisms of spasm and hemorrhage, prevention of stroke, genetics/predisposing risk factors, and much more.[books.google.ro]
  • […] mutism [ mu tizm ] inability or refusal to speak, most often because deafness has prevented the person from hearing the spoken word. speech is learned by imitating the speech of others.[medical-dictionary.thefreedictionary.com]
  • Tacrolimus: an alternative for graft-versus-host disease prevention . Ann Pharmacother 2000; 34 : 377–381. 2. Bechstein WO . Neurotoxicity of calcineurin inhibitors: impact and clinical management . Transpl Int 2000; 13 : 313–326. 3.[nature.com]

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