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]
Entire Body System
- Movement Disorder
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]
References 1 Clonic perseveration following 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 [academic.oup.com]
Fetal Akinesia Fetal akinesia is characterized by a total lack of fetal movement. This total lack of fetal movement is due to a number of disorders that ultimately results to the inability to initiate movement or akinesia. [allhealthsite.com]
Respiratoric
- Hypophonia
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. [ncbi.nlm.nih.gov]
Later on due to sustained unaware hypoglycemic state, he developed prolonged delirium followed by severe extra pyramidal symptoms in the form of akinesia, rigidity (axial and appendicular), bradyphrenia, and severe hypophonia with postural instability [ijcasereportsandimages.com]
One report describes a bilateral, distal anterior cerebral artery territory stroke resulting in isolated ischemic lesions in both SMA-proper with resultant spastic paraplegia and hypophonia. [hoajonline.com]
Cardiovascular
- Hypertension
Premorbidly, she had been functionally independent, with a history of hypertension, osteoarthritis, osteoporosis and glaucoma. She had never smoked or consumed alcohol. [academic.oup.com]
[…] production of IL-2, thereby inhibiting proliferation of antigen-specific T lymphocytes. 1 It is estimated to be 50–200 times more potent than cyclosporin (CYA) and is now commonly used after allo-SCT to prevent GVHD. 1 Although common adverse effects like hypertension [nature.com]
The most likely etiology of transient deficits following SSS ligation is venous hypertension and edema, but these are readily detected on postoperative CT perfusion or MRI studies. [hoajonline.com]
Eyes
- Vertical Gaze Palsy
Mesencephalic damage is typically characterised by vertical gaze palsy and ophthalmoplegia. Interestingly, six patients from the selected group showed disorders of the ocular motor control and two patients a vertical gaze palsy. [doi.org]
It is characterized by vertical gaze palsy and ophthalmoplegia. This state of akinetic mutism varies in intensity, but it is distinguished by drowsiness, lack of motivation, hyper-somnolence, and reduction in spontaneous verbal and motor actions. [en.wikipedia.org]
We believe that the ‘ptosis’ documented by ED physicians was in fact a combination of hypersomnia with vertical gaze palsy. [academic.oup.com]
- Blepharoptosis
クローヌス、足間代 aphasia失語[症] apoplexy脳卒中 aseptic meningitis無菌[性]髄膜炎 ataxia運動失調 ataxic gait失調[性]歩行 athetosisアテトーシス auditory nerve聴神経 autonomic disturbance自律神経障害 axon 軸索 axon terminals 軸索終末 b Bell's palsyベル麻痺 benign positional vertigo良性頭位性眩暈 biceps reflex二頭筋反射 blepharoptosis [tokyo-med.ac.jp]
Psychiatrical
- Suggestibility
Subsequently, two of the patients showed signs of pseudobulbar palsy with abnormalities in the pons on MRI scanning, suggesting central pontine myelinolysis (CPM). [ncbi.nlm.nih.gov]
Neurologic
- Akinesia
An apathetic, amotivational state persisted despite resolution of akinesia and normal frontal executive functions. AKM may respond to dopaminergic treatment even after months of severe akinesia. [ncbi.nlm.nih.gov]
The term mutism is … Medical dictionary Akinesia — Impaired body movement; without movement (or without much movement). Akinesia is a term used in neurology to denote the absence (or poverty) of movement. [enacademic.com]
Fetal Akinesia Fetal akinesia is characterized by a total lack of fetal movement. This total lack of fetal movement is due to a number of disorders that ultimately results to the inability to initiate movement or akinesia. [allhealthsite.com]
- Seizure
Postanoxic encephalopathy, central nervous system infection and chronic seizure disorders are the major causes of BIPLEDs. However, BIPLEDs may occur in bilateral ACA territory infarction. [ncbi.nlm.nih.gov]
We prescribed phenytoin for suspected seizures. An electroencephalogram (EEG) showed diffuse slowing but no epileptiform activity. [academic.oup.com]
Partial loss of such grating processes would attend hyperkinetic mutism, akinetic mutism, or temporal lobe seizures. [www-users.med.cornell.edu]
Seizures were controlled with intravenous phenytoin and diazepam. The next day, the patient was noticed to be more alert. He was opening his eyes, had spontaneous blinking and was following the examiner with his eyes. [neurologyindia.com]
- Abulia
Following the TBI, he developed abulia (decreased activity and speech) that worsened over approximately a year. [ncbi.nlm.nih.gov]
Abulia is a state in which the person loss or deficiency of will power, initiative, or drive. Akinetic mutism is a medical term describing patients tending neither to move (akinesia) nor speak (mutism). [heejoogwenkim.org]
Called also abulia. selective mutism a mental disorder of childhood characterized by continuous refusal to speak in social situations when the child is able and willing to speak to selected persons. a·ki·net·ic mut·ism a persistent state of altered consciousness [medical-dictionary.thefreedictionary.com]
[…] in all assigned tasks and perseveration 4. frontal release (disinhibition) signs (sucking, grasping, groping reflexes) = utilization behaviors, paratonic rigidity (gegenhalten) 5. akinesia and lack of initiative and spontaneity (apathy, anhedonia and abulia [neuroweb.us]
- Encephalopathy
Postanoxic encephalopathy, central nervous system infection and chronic seizure disorders are the major causes of BIPLEDs. However, BIPLEDs may occur in bilateral ACA territory infarction. [ncbi.nlm.nih.gov]
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. [doi.org]
- Dysarthria
Mutism and persistent dysarthria due to tacrolimus-based immunosupression following allogenic liver transplantation. Am J Ther 2010; 18 : e274–e2766. 9. Ahn K, Lee JW, Hahn ST, Yang DW, Kim PS, Kim HJ et al. [nature.com]
Frequently reported features, which may fluctuate, include akinetic mutism, gaze palsies, dysarthria, hypersomnia and amnesia (thalamic dementia). [academic.oup.com]
[…] if entirely prefrontal): contralateral spastic hemiplegia 2. speech and language disorder (dominant hemisphere): laconic speech, lack of spontaneity of speech, telegraphic speech (agrammatism), loss of fluency, perseveration, tendecy to whisper and dysarthria [neuroweb.us]
After four weeks of treatment he started responding and recognizing family members with severe hypo kinetic dysarthria and generalized rigidity. Repeat MRI of brain after four weeks showed resolution of all previous lesions. [ijcasereportsandimages.com]
Speech disorders with phonematic or semantic paraphasia, dysarthria, perseverations, and impairments in speech understanding were seen in only five cases at the onset. [doi.org]
Workup
EEG
- Epileptiform Activity
An electroencephalogram (EEG) showed diffuse slowing but no epileptiform activity. [academic.oup.com]
Electroencephalography revealed 3- to 4-Hz delta slowing most prominently seen over both frontotemporal regions with superimposed occasional 6- to 8-Hz activity but no epileptiform activity. [journals.lww.com]
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]
Etiology References: [1] [2] [3] [4] [5] Clinical features Locked-in syndrome is typically preceded by a loss of consciousness and subsequent coma lasting for days or weeks. [amboss.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]
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.de]
Prevention
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.de]
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]
[…] 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]