Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- 1 Evaluation of cognitive and behavioral disorders in the stroke unit
- Motor and gestural disorders
- Aphasia and arthric disorders
- Hemineglect, Anton–Babinski and right hemisphere syndromes
- Agnosia and Bálint's syndrome
- Executive and memory disorders
- Behavioral and mood disorders
- 22 Akinetic mutism and related disorders
- 23 Alterations of level of consciousness related to stroke
- 24 Delirium and confusional state in stroke patients
- 25 Post-stroke delusion
- 26 Acute behavioral and mood changes
- 27 Stroke and personality change
- 28 Post-stroke mania
- 29 Depression after stroke
- 30 Fatigue
- Dementia and anatomical left/right syndromes
- Index
- References
22 - Akinetic mutism and related disorders
Published online by Cambridge University Press: 10 October 2009
Book contents
- Frontmatter
- Contents
- Contributors
- Preface
- 1 Evaluation of cognitive and behavioral disorders in the stroke unit
- Motor and gestural disorders
- Aphasia and arthric disorders
- Hemineglect, Anton–Babinski and right hemisphere syndromes
- Agnosia and Bálint's syndrome
- Executive and memory disorders
- Behavioral and mood disorders
- 22 Akinetic mutism and related disorders
- 23 Alterations of level of consciousness related to stroke
- 24 Delirium and confusional state in stroke patients
- 25 Post-stroke delusion
- 26 Acute behavioral and mood changes
- 27 Stroke and personality change
- 28 Post-stroke mania
- 29 Depression after stroke
- 30 Fatigue
- Dementia and anatomical left/right syndromes
- Index
- References
Summary
General characteristics of akinetic mutism
Neuropsychological deficits are of major importance in stroke patients: they are frequent, have a major diagnostic value as they may be the only clinical manifestation of stroke, require a specific management, and are a major determinant of residual disability. This chapter will focus on the main characteristics of akinetic mutism and related disorders, which are sometimes classified as “coma-like states.”
Clinical description
The main characteristics of akinetic mutism and related disorders that may be misdiagnosed with akinetic mutism are summarized in the Key points table. All these conditions may occur after a coma of a variable length of time, and represent a favorable step between a comatose state and return to normality. The main difference between these conditions and coma is that sleep–wake cycles are present. This differentiation is important to determine the prognosis and to choose the most appropriate therapeutic strategy.
Akinetic mutism
Akinetic mutism is also called “abulia major,” and was formerly called “coma vigile.” Patients with akinetic mutism appear alert or at least wakeful, because their eyes are open and they have active gaze movements. They are mute and immobile, but they are able to follow the observer or moving objects with their eyes, to whisper a few monosyllables, and to have slow feeble voluntary movements under repetitive stimuli. The patients can answer questions, but otherwise never voluntarily start speaking. In extreme circumstances such as noxious stimuli, they can become agitated and even say appropriate words.
Information
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- Chapter
- Information
- The Behavioral and Cognitive Neurology of Stroke , pp. 444 - 454Publisher: Cambridge University PressPrint publication year: 2007
References
, , , et al. (2000). Mutism akinétique et syndrome simulant une paralysie supranucléaire progressive après dérivation d'une hydrocéphalie obstructive. Efficacité d'un traitement par bromocriptine: Deux cas. Rev. Neurol. (Paris), 156, 380–3.Google Scholar
(2001). Chronic akinetic mutism after mesencephalic-diencephalic infarction: Remediated with dopaminergic medications. Neurorehabil. Neural Repair, 15, 151–6.CrossRefGoogle ScholarPubMed
(1994). Conséquences des lésions des noyaux gris centraux sur l'activité métabolique cérébrale: Implications cliniques. Rev. Neurol. (Paris), 150, 599–604.Google Scholar
and (1994). The behavioural and motor consequences of focal lesions of the basal ganglia in man. Brain, 117, 859–76.CrossRefGoogle ScholarPubMed
, , , et al. (1991). Loss of psychic self-activation with bithalamic infarction. Neurobehavioural, CT, MRI and SPECT correlates. Acta Neurol. Scand., 83, 309–16.CrossRefGoogle ScholarPubMed
, , , and (1994). Bilateral infarction in the anterior cerebral artery vascular territory due to an unusual anomaly of the circle of Willis. Stroke, 25, 1279–81.CrossRefGoogle Scholar
, , and (1975). Mutisme akinetique et ramollissement bicingulaire. Trois cas anatomo-cliniques. Rev. Neurol. (Paris), 131, 121–31.Google Scholar
, , and (1941). Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain, 64, 273–90.CrossRefGoogle Scholar
, , and (2003). Locked-in syndrome: Improvement in the prognosis after an early intensive multidisciplinary rehabilitation. Arch. Phys. Med. Rehabil., 84, 862–7.CrossRefGoogle ScholarPubMed
, , , et al. (1981). Paramedian thalamic and midbrain infarct: Clinical and neuropathological study. Ann. Neurol., 10, 127–48.CrossRefGoogle ScholarPubMed
(1984). Locked-in state with bilateral internal capsule infarcts. Neurology, 34, 1365–7.Google ScholarPubMed
, and (1993). Accuracy of diagnosis of persistent vegetative state. Neurology, 43, 1465–7.CrossRefGoogle ScholarPubMed
, and (1990). Infarctus putamino-capsulo-caudés bilatéraux, symmétriques et simultanés. Rev. Neurol. (Paris), 146, 415–19.Google Scholar
, , and (2003). Impairment, activity, participation, life satisfaction, and survival in persons with locked-in syndrome for over a decade: Follow-up on a previously reported cohort. J. Head Trauma Rehabil., 18, 435–44.CrossRefGoogle Scholar
and (1992). Bilateral anterior cerebral artery territory infarction in the differential diagnosis of basilar artery occlusion. J. Neurol., 239, 162–4.CrossRefGoogle ScholarPubMed
(1983). Honored guest presentation: Abulia minor vs. agitated behavior. Clin. Neurosurg., 31, 9–31.CrossRefGoogle ScholarPubMed
, and (1983). A cerebrovascular accident with unusual features. Stroke, 14, 808–10.CrossRefGoogle ScholarPubMed
and (1995). Outcome after severe traumatic brain injury: Coma, the vegetative state, and the minimally responsive state. J. Head Trauma Rehabil., 10, 40–56.CrossRefGoogle Scholar
, , , and (1989). Spontaneous bilateral anterior cerebral artery occlusion resulting in akinetic mutism. A case report. Acta Neurol. (Napoli), 11, 252–8.Google ScholarPubMed
and (1988). Perte de vitalité, d'intérêt et des affects (syndrome athymormique) dans des lésions lacunaires du striatum. Rev. Neurol. (Paris), 144, 571–7.Google Scholar
., . and (1985). Syndrome of the mesencephalic artery: Report of a case with CT and necropsy findings. J. Neurol. Neurosurg. Psychiatry, 48, 1179–81.CrossRefGoogle ScholarPubMed
and (2003). Locked-in syndrome due to metastatic pontomedullary tumor – case report. Neurol. Med. Chir. (Tokyo), 43, 497–500.CrossRefGoogle ScholarPubMed
., and (1974). “Locked-in” state with bilateral midbrain infarcts. Arch. Neurol., 30, 176–8.CrossRefGoogle ScholarPubMed
., and (1967). State resembling akinetic mutism in basilar artery occlusion. Neurology, 17, 74–80.CrossRefGoogle ScholarPubMed
, , , et al. (2003). Yawning despite trismus in a patient with locked-in syndrome caused by a thrombosed megadolichobasilar artery. Clin. Neurol. Neurosurg., 106, 44–6.CrossRefGoogle Scholar
, , and (1982). Perte d'autoactivation psychique. Activité compulsive obsessionnelle. Lésions lenticulaire bilatérale. Rev. Neurol. (Paris), 138, 137–41.Google Scholar
, ., . and (1984). Pure psychic akinesia with bilateral lesions of basal ganglia. J. Neurol. Neurosurg. Psychiatry, 47, 377–85.CrossRefGoogle ScholarPubMed
, ., and (1981). Bilateral infarction of the anterior cingulate gyri and of the fornices. Report of a case. J. Neurol. Sci., 51, 289–300.CrossRefGoogle ScholarPubMed
, , and (1963). Troubles de conscience et mutise akinétique. Etude anatomoclinique d'un ramollissement bilatéralparamédian des pédoncules cérébraux et du thalamus. Rev. Neurol. (Paris), 109, 115–31.Google Scholar
, , and (1982). Recovery from the ‘locked-in’ syndrome. Arch. Neurol., 39, 145–7.CrossRefGoogle ScholarPubMed
and (1997). Akinetic mutism: Disconnection of frontal-subcortical circuits. Neuropsychiatry Neuropsychol. Behav. Neurol. 10, 254–9.Google ScholarPubMed
, , , and (1995). Syndrome athymormique du à un infarctus striato-capsulaire. Maladie de Moya-Moya de l'adulte. Rev. Neurol. (Paris), 151, 383–7.Google Scholar
and (1999). Bilateral infarction in the territory of the anterior cerebral arteries. Neurology, 52, 886–8.CrossRefGoogle ScholarPubMed
, , and (2004). Akinetic mutism following stroke. J. Clin. Neurosci., 11, 25–30.CrossRefGoogle ScholarPubMed
and (1993). Painful tonic spasms associated with subcortical infarction. Acta Neurol. (Napoli), 15, 87–91.Google ScholarPubMed
, , , et al. (2002). Akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma. Eur. J. Neurol., 9, 311–13.CrossRefGoogle Scholar
, , and (1980). Psychiatric symptoms in ruptured anterior communicating aneurysms: Social prognosis. Acta Psychiatr. Scand., 61, 306–12.CrossRefGoogle ScholarPubMed
and (1986). Locked-in syndrome: A review of 139 cases. Stroke, 17, 758–64.CrossRefGoogle ScholarPubMed
, , and (1995). Selective bilateral lesion of the globus pallidus: Ten-year follow-up of memory impairment and frontal symptomatology. Ital. J. Neurol. Sci., 16, 635–40.CrossRefGoogle ScholarPubMed
, and (2003). Bromocriptine-responsive akinetic mutism following endoscopy for ventricular neurocysticercosis. Case report and review of the literature. J. Neurosurg., 99, 397–401.CrossRefGoogle ScholarPubMed
, , , et al. (1989). Post traumatic extracranial vertebral artery dissection with locked-in syndrome: A case with MRI documentation and unusually favourable outcome. J. Neurol. Neurosurg. Psychiatry, 52, 1191–3.CrossRefGoogle ScholarPubMed
Richfield, E. K., Twyman, R. and Berent, S. (1987). Neurological syndrome following bilateral damage to the head of the caudate nuclei. Ann. Neurol., 22, 768–71.CrossRef
and (1981). Akinetic mutism from hypothalamic damage: Successful treatment with dopamine agonists. Neurology, 31, 1435–9.CrossRefGoogle ScholarPubMed
(1970). Cerebral vascular disease and behavior. I. The syndrome of the mesencephalic artery (basilar artery bifurcation). Arch. Neurol., 22, 408–18.CrossRefGoogle Scholar
, , , et al. (1993). Clinical determinants of dementia related to stroke. Ann. Neurol., 33, 568–75.CrossRefGoogle Scholar
, and (1995). Strategic infarcts in vascular dementia. A clinical and brain imaging experience. Arzneimittelforschung, 45, 371–85.Google ScholarPubMed
, and (2004). Frontal lobe and cingulate cortical metabolic dysfunction in acquired akinetic mutism: A PET study of the interval form of carbon monoxide poisoning. Brain Inj., 18, 615–25.CrossRefGoogle ScholarPubMed
, , , and (2003). Transient locked-in syndrome resulting from stellate ganglion block in the treatment of patients with sudden hearing loss. Acta Anaesthesiol. Scand., 47, 485–7.CrossRefGoogle ScholarPubMed
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