ABSTRACT
RATIONALE: A 72-year-old male had suffered from head trauma resulting from injury to his frontal area by an electrical grinder while working at his home. PATIENT CONCERNS: He lost consciousness for approximately 10 minutes and experienced continuous post-traumatic amnesia. DIAGNOSES: He was diagnosed as traumatic intracerebral hemorrhage in both frontal lobes, intraventricular hemorrhage, and subarachnoid hemorrhage, and underwent decompressive craniectomy and hematoma removal. INTERVENTIONS: The patient's Glasgow Coma Scale score was 5. At 2 months after onset, when starting rehabilitation, he showed no spontaneous movement or speech; he remained in a lying position all day with no spontaneous activity. OUTCOMES: On 2-month diffusion tensor tractography, decreased neural connectivity of the caudate nucleus to the medial prefrontal cortex (PFC, Broadmann area [BA]: 10 and 12) and orbitofrontal cortex (BA 11 and 13) was observed in both hemispheres. LESSONS: Akinetic mutism following prefrontal injury.
Subject(s)
Akinetic Mutism , Cerebral Hemorrhage, Traumatic , Decompressive Craniectomy , Prefrontal Cortex , Accidents, Home , Aged , Akinetic Mutism/diagnosis , Akinetic Mutism/etiology , Akinetic Mutism/physiopathology , Akinetic Mutism/surgery , Cerebral Hemorrhage, Traumatic/diagnosis , Cerebral Hemorrhage, Traumatic/etiology , Cerebral Hemorrhage, Traumatic/surgery , Decompressive Craniectomy/adverse effects , Decompressive Craniectomy/methods , Diffusion Tensor Imaging/methods , Electrical Equipment and Supplies , Glasgow Coma Scale , Humans , Male , Prefrontal Cortex/diagnostic imaging , Prefrontal Cortex/injuries , Treatment OutcomeABSTRACT
A 26-year-old male with large intraventricular meningioma developed acute hydrocephalus postoperatively, which was difficult to manage. After a repeated course of dilated and slit-like ventricle, he gradually presented a disturbance of consciousness, which was recovered by the use of bromocriptine, suggesting akinetic mutism. At the chronic stage, he suffered from symptoms of hydrocephalus again. Time-slip MRI revealed the stasis of CSF flow around the third ventricle. Neuroendoscopy disclosed that the foramen of Monro was occluded with membrane. After endoscopic third ventriculostomy as well as penetration of the foramen, the symptoms disappeared and hydrocephalus was resolved. This is a rare case of akinetic mutism after complicated management of hydrocephalus associated with intraventricular meningioma.
Subject(s)
Akinetic Mutism/surgery , Hydrocephalus/surgery , Meningioma/surgery , Adult , Akinetic Mutism/diagnosis , Akinetic Mutism/etiology , Humans , Hydrocephalus/complications , Magnetic Resonance Imaging , Male , Meningioma/complications , Meningioma/diagnosis , Neuroendoscopy/methods , Third Ventricle/pathology , Third Ventricle/surgery , Treatment Outcome , Ventriculostomy/methodsABSTRACT
Two rare cases of akinetic mutism induced by aneurysmal subarachnoid haemorrhage are reported. 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.
Subject(s)
Akinetic Mutism/etiology , Subarachnoid Hemorrhage/complications , Adult , Akinetic Mutism/diagnostic imaging , Akinetic Mutism/surgery , Brain/diagnostic imaging , Cerebral Angiography , Female , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Aneurysm/surgery , Subarachnoid Hemorrhage/diagnostic imaging , Subarachnoid Hemorrhage/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Results of clinical and psychological examinations of 10 patients with various manifestations of speech akinesia are presented. Four of these patients have developed the syndrome of akinetic mutism. An analysis of the time course of the akinetic mutism formation and a comparison of the symptoms of its initial stage with the manifestations of the speech akinesia observed in the course of stereotaxic operations performed for therapeutic purpose in 6 patients with extrapyramid system diseases allow a conclusion that there exists a common mechanism of various manifestations of speech akinesia consisting in insufficiency of motivation stimulation. Data of anatomo-histopathological examination of the brain of 2 patients who had the akinetic mutism point to a great rle of the frontal divisions of the cortex and its associative connections in the complicated, multi-level structural and functional basis of speech akinesia.
