A spectrum of motivational impairment has abulia at one end and akinetic mutism at the other. Ddm are not classified as disorders within dsm5, and it remains unclear if they are. The aim of this study was to delimit the symptom of akinetic mutism. Akinetic mutism was first described in 1941 as a mental state where patients lack the ability to move or speak. Akinetic mutism after subarachnoid haemorrhage njcc the. Messert et al 10 reported akinetic mutism as a consequence of obstructive hydrocephalus. We report on two cases of transient akinetic mutism after massive subarachnoid haemorrhage due to the rupture of an intracranial aneurysm of the anterior cerebral artery aca. The anterior cingulate cortex acchas been identified as part of a supervisoryattentional network for selecting alternativemotor programs in response to topdown corticalprocessing, particularly in situationsinvolving conflicting cognitive tasks. This type of mutism is caused by bilateral damage to the frontal lobe area of the brain which is responsible for arousal and motivation as it hold the dopamine. It is a serious sequela of brain injury in terms of absolute need for a caregiver and loss of working ability.
Akinetic mutism is a medical term describing patients tending neither to move nor speak. The aim of this study was to delimit the symptom of akinetic mutism in patients with. Akinetic mutism after fourth ventricle choroid plexus. Akinetic mutism in a bone marrow transplant recipient. Akinetic mutism is often due to damage to the frontal lobes of the brain. However, their eyes may follow their observer or be diverted by sound. The payee may view, download, andor print the article for hisher personal, scholarly, research, and educational use. Treatment of akinetic mutism with intramuscular olanzapine. His pharmacologic response was consistent with animal models of hypothalamicinduced akinetic.
Patients with akinetic mutism sporadically follow commands but this can show considerable fluctuation. Akinetic mutism definition, symptoms, causes, treatment. The other is known as hyper pathic akinetic mutism and is associated. Postoperatively, the patient developed the clinical syndrome of akinetic mutism, but her condition improved after the administration of the dopaminergic agonist bromocriptine. Akinetic mutism as a classification criterion for the diagnosis of. Akinetic mutism is an extreme form of this state and is very rare. One is related to the mesencephalic region and is described as apathetic akinetic mutism or somnolent mutism. Akinetic mutism and parkinsonism associated with obstructive hydrocephalus. Akinetic mutism is described in various clinical presentations but typically is defined as a state wherein the patient appears awake but does not move or speak. Akinetic mutism article about akinetic mutism by the free. Apr 01, 2006 after 6 weeks of severe akinetic mutism refractory to one ect treatment and trials of steroids and stimulants, the patient recovered spontaneously over a 2month period. Jun 18, 2012 tacrolimusinduced akinetic mutism is an uncommon but serious complication, described in solid organ transplant patients, 3, 4, 5, 6, 7, 8 and only in one stem cell. However, alertness, visual fixation, motor and sensory functions and some fundamental cognitive abilities are preserved1,2.
Bilateral injury of the frontosubcortical circuit is a possible pathogenetic mechanism of am. Am akinetic mutism, ba broadmann area, cn caudate nuscleus, dtt diffusion tensor tractography, pfc prefrontal cortex. The health problem is tied in with destruction to the anterior ungulate gyrus and secondary motor region in the mesial section of the frontal lobes. The severity of the akinesia and mutism usually impairs any relational exchange with others, and. One patient in addition developed a florid orofacial dyskinesia, which resolved completely, as did the akinetic mutism, after withdrawal of cyclosporin. The icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes. Akinetic mutism can be caused by a variety of things.
The child who is born with normal hearing and then loses it may lose part or all of the power of speech through loss of contact with the speech of. Mutism definition and meaning collins english dictionary. Baclofen, a derivative of the inhibitory neurotransmitter gammaaminobutyric acid, is useful for reducing frequency and severity of flexor or extensor muscle spasms 1. Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Akinetic mutism medigoo health medical tests medical. Disorders of diminished motivation ddmincluding apathy, abulia, and akinetic mutism are characterized by impairment in goaldirected behavior, thought, and emotion. More detailed information about the symptoms, causes, and treatments of akinetic mutism is available below symptoms of akinetic mutism. Relief of akinetic mutism from obstructive hydrocephalus. Conclusion diffuse brain damage underlies akinetic mutism in patients with. Payperview content is for the use of the payee only, and content may not be further distributed by print or electronic means. Unique presentation of akinetic mutism and coexisting.
Muteness results in the complete absence or at least a significant loss of verbal communication. Patients lack most motor functions such as speech, facial expressions, and gestures, but demonstrate apparent alertness. On the pathophysiology and treatment of akinetic mutism. When a causative lesion is located in the frontal lobe, favorable responses to ldopa or dopamine agonists such as bromocriptine have been reported. Clonic perseveration is an unusual but well recognised sign which may be mistaken for seizures. Bilateral paramedian thalamic infarction is an uncommon but recognised cause of akinetic mutism and clonic perseveration. Occurring mainly in shy, timid, physically weak children, mutism results from a reaction to a traumatic mental stimulus such as fright, insult, conflict, or excessive. Akinetic mutism and the story of david request pdf. Akinetic mutism is not a state like paralysis, in akinetic mutism it all depends upon the patients will to move and speak. Akinetic mutism after baclofen annals of internal medicine.
Unique presentation of akinetic mutism and coexisting thyroid. In these patients the time course of the akinetic mutism. Pdf persistent vegetative state, akinetic mutism and. Case report unique presentation of akinetic mutism and. Akinetic rnutism from hypothalamic damage neurology. Akinetic mutism abulia akinetic mutism is a state of limited responsiveness to the environment in the absence of gross alteration of sensorimotor mechanisms operating at a more peripheral level. We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following totalbody irradiation and amphotericin b chemoprophylaxis. Akinetic mutism following stroke request pdf researchgate. Akinetic mutism is an unusual mental state in which the patient is mute, generally unresponsive and unwilling to perform even simple motor activity. Pdf episodically remitting akinetic mutism following.
Recovery of akinetic mutism and injured prefrontocaudate. Mutism the inability or refusal to speak that takes place in the absence of any organic lesions of the vocal apparatus. Reversible akinetic mutism after aneurysmal subarachnoid. Following the landmark case report of cairns et al. Disorders of diminished motivation ddmincluding apathy, abulia, and akinetic mutismare characterized by impairment in goaldirected behavior, thought, and emotion. An acute brainstem lesion seen on mri may explain this patients akinetic mutism. Akinetic mutism following bilateral anterior cerebral artery territory infarction due to aneurysm. However, in this case, the affected individual is alert and heshe may make active eye movements in response to a person or sound.
The syndrome has been reported with lesions in the region of the third ventricle 1,4,68 thalamus, and basal ganglia, 9 midbrain, 12,1416 anterior cingulate gyrus, 1719 and. Brust, angel chamorro, in stroke sixth edition, 2016. Akinetic mutism has been anatomically divided into two formsthe mesencephalic form and the frontal form. The full syndrome of akinetic mutism or abulia has thus not been produced in animals by experimental cingulectomy or in humans by surgical cingulectomy, and even bilateral aca ligation in humans has on occasion failed to cause the syndrome. Differentiating akinetic mutism from coma is difficult.
Request pdf akinetic mutism following stroke this is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. A trial of highdose bromocriptine did not stimulate purposeful verbal or motor activity. Muteness or mutism is medically defined as a speech affliction wherein the patient is unable to have the normal capacity to speak. The case study of a 53yearold male patient who developed akinetic mutism for a period of 7 months after a subarachnoid. Akinetic mutism am is a rare neurological disorder characterized by the presence of an intact level of. Akinetic mutism symptoms, diagnosis, treatments and causes. More detailed information about the symptoms, causes, and treatments of akinetic mutism is available below. In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. Subarachnoid haemorrhage and akinetic mutism request pdf.
Patients lack most motor functions such as speech, facial expressions, and gestures, but demonstrate. Bilateral paramedian thalamic infarction is an uncommon but recognised cause of akinetic mutism. Objectives among the classification criteria for the diagnosis of creutzfeldtjakob disease, akinetic mutism is described as a symptom which helps to establish the diagnosis as possible or probable. Akinetic mutism as a classification criterion for the. Akinetic mutism related symptoms are more likely resemble the symptoms of shock. Objectivesamong the classification criteria for the diagnosis of creutzfeldtjakob disease, akinetic mutism is described as a symptom which helps to establish the diagnosis as possible or probable. Clinical and experimental aspects of akinetic mutism. Bilateral lesions to the acc may be causallyassociated with akinetic mutism, where patientsare unable to. A b c 1 periodic sharp 1 myoclonus wave complexes on routine 2 visual or eeg during an investigations that cerebellar signs illness of any do not indicate an duration alternative 3 pyramidal diagnosis extrapyramidal signs 2 positive 1433 csf assay in 4 akinetic mutism patients with a disease duration of less than 2 years 3 mri high signal abnormalities in caudate nucleus and. After 6 weeks of severe akinetic mutism refractory to one ect treatment and trials of steroids and stimulants, the patient recovered spontaneously over a 2month period. Persistent vegetative state, akinetic mutism and consciousness.
Patients with am maintain an intact level of consciousness, attention, language, and sensorimotor capacity, but present with a simultaneous decrease in goaldirected behavior, and emotion. Pdf akinetic mutism following bilateral anterior cerebral artery. It is a term that is used medically and is believed to be associated with the mental state of an affected individual. Patients may open their eyes and seem alert, and brief movement. Akinetic mutism definition of akinetic mutism by the free. Akinetic mutisma serious complication to tacrolimusbased. Jan 01, 2008 6 thus, the treatment for akinetic mutism can be readily aimed at dysfunction in this region of the brain. One patient was mute without being akinetic and four patients were comatose. The aim of this study was to delimit the symptom of akinetic mutism in patients with creutzfeldtjakob disease from the complex of symptoms of an apallic syndrome and to assign it to the individual forms. This result indicates that a disruption in the ascending dopaminergic pathway involved in behavior formation was likely the cause of these neurological symptoms. Akinetic mutism and parkinsonism associated with obstructive. When the patient is literally akinetic and mute, however, the condition must be differentiated from true stupor or coma, a lockedin state, extrapyramidal akinesia.
Prolonged akinetic mutism due to multiple sclerosis the. Akinetic mutism article about akinetic mutism by the. With a report of the associated disturbance of brain potentials. Akinetic mutism is a medical term describing patients tending neither to move akinesia nor. Akinetic mutism and bilateral anterior cerebral artery occlusion. Akinetic mutism from frontal lobe damage responding to.
The anterior cingulate cortex, akinetic mutism, and human. Case report unique presentation of akinetic mutism and coexisting thyroid storm relating to stroke mohankumarkurukumbi, 1 thaodang, 1,2 najeebcrossley, 1,2 aliceesame, 1,2 andannapurnijayamtrouth 1 department of neurology, howard university hospital, georgia avenue, washington, dc, usa. A state in which a person is unable to speak mute or move akinetic. Episodically remitting akinetic mutism following subarachnoid hemorrhage article pdf available in journal of neuropsychiatry 111. Akinetic mutism am is defined as a complete absence of spontaneous behavior and speech. During the eight years of her illness she had several periods of akinetic or trancelike mutism in which she was essentially inert with her. Akinetic mutism is generally associated with bilateral lesions of the medial frontal lobes. In which patient lack some motor activities like movement of facial muscles to show facial expressions and gestures. Cyclosporinassociated akinetic mutism and extrapyramidal. This is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. The payee may view, download, andor print the article for hisher personal, scholarly, research, and educational. Tacrolimusinduced akinetic mutism is an uncommon but serious complication, described in solid organ transplant patients, 3, 4, 5, 6, 7, 8 and only in one stem cell.
Three patients developed akinetic mutism on the third day after the introduction of intravenous cyclosporin a, given for immunosuppression after liver transplantation. Akinetic mutism definition, a state of apparent alertness with normal eye movements but no speech or other voluntary motion, usually due to a stroke. This work was supported by the medical research center program 2015r1a5a2009124 through the national research foundation of korea nrf funded by the ministry of science, ict and future planning. Pdf akinetic mutism following stroke nages nagaratnam. A patient with akinetic mutism after surgical removal of a tumor from the anterior hypothalamus responded to treatment with lergotrile and bromocriptine dopamine receptor agonists but not to carbidopdldopa or methylphenidate presynaptic dopamine mimetics. Akinetic mutism definition of akinetic mutism by medical. It often occurs after brain injury or as a symptom of other diseases.
Akinetic mutism am is a rare neurological disorder of impaired initiation and motivation for behavior. Request pdf on aug 1, 2000, onofre combarros and others published akinetic mutism from frontal lobe damage responding to levodopa find, read and cite all the research you need on researchgate. Although patients with similar clinical syndromes had been described earlier, the term akinetic mutism came into use following a report in 1941 by cairns et al 4 of a 14yearold girl with an epidermoid cyst of the third ventricle. Mutism in the older adult depending on the clinical pictur e, am had been subdivided into two pathology types based on the anatomic location of the lesion. Akinetic mutism related to mutism caused by brain injury, many of people who suffer from this type of mutism are completely unable to move akinesia and are unable to produce language because of the disorder.
Akinetic mutism is characterized by an individuals inability to move or speak. Akinetic mutism is often the result of severe frontal lobe injury in which the pattern of inhibitory control is one of increasing passivity and gradually decreasing speech and motion. I report an unusual reaction in a patient with renal failure, who developed a state of motionless, mindless wakefulness after a single dose of baclofen. Akinetic mutism following prefrontal injury by an electrical grinder a case report. Akinetic mutism has a number of causes with varied pathology and is characterized by a marked reduction in motor function, including facial expression, gestures, and speech output, with awareness.
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