01 January 2005
Prolonged rigid mutism following involvement of the frontal subcortical and forebrain dopaminergic systems due to right fronto-parietal haemorrhage
Nages Nagaratnam, Ilesh PatelCase Rep Clin Pract Rev 2005; 6:177-181 :: ID: 428852
Abstract
Background: Akinetic mutism is a state of apparent alertness with normal eye movements with no volitional motor function or speech output. It may be due to a number of causes and often follows a stroke. It usually lasts from days to weeks but less commonly for months to years. Case Report: A 72-year-old right-handed man with rigid mutism due to a right fronto-parietal haematoma is described. Serial CT scans of the brain revealed a large haemorrhage with surrounding infarction in the right fronto-parietal region at the level of the centrum semi-ovale and the right periventricular white matter. There was midline shift with compression of the adjacent left cerebral hemisphere involving the motor and supplementary motor areas as well as the prefrontal regions in both hemispheres. There was total weakness of the left side. On the right, a mixed picture of pyramidal and extrapyramidal signs was found, with increased tone of the cogwheel type, ankle clonus and equivocal plantar response and frontal release signs,. There was no verbal output for 20 weeks with marked akinesia. He had no buccofacial apraxia but had overall reduction in prosody and gesturing. At the end of eighteen months he remained mute.Conclusions: This specific type of prolonged rigid akinetic mutism could be explained by damage to the frontal lobe and or interruption of the complex frontal subcortical circuits and involvement of the forebrain dopaminergic and basal ganglia systems.
Keywords: akinetic mutism, Stroke, cerebral haemorrhage, supplementary motor area
42
In Press
14 Mar 2024 : Case report
Simultaneous Occurrence of Collagen Type III Glomerulopathy and Immunoglobulin A Nephropathy: A Rare Case R...Am J Case Rep In Press; DOI: 10.12659/AJCR.942770
16 Mar 2024 : Case report
Castleman Disease Presenting in the Neck: A Report of 3 Cases and a Literature ReviewAm J Case Rep In Press; DOI: 10.12659/AJCR.943214
16 Mar 2024 : Case report
Early Diagnosis and Successful Empirical Treatment of L1-L2 Spondylodiscitis in a 21-Month-Old Girl: A Case...Am J Case Rep In Press; DOI: 10.12659/AJCR.943010
16 Mar 2024 : Case report
A Rare Autochthonous Case of Hepatic Hydatid Cyst in the Non-Endemic Region of TaiwanAm J Case Rep In Press; DOI: 10.12659/AJCR.943687
Most Viewed Current Articles
07 Mar 2024 : Case report
Neurocysticercosis Presenting as Migraine in the United StatesDOI :10.12659/AJCR.943133
Am J Case Rep 2024; 25:e943133
10 Jan 2022 : Case report
A Report on the First 7 Sequential Patients Treated Within the C-Reactive Protein Apheresis in COVID (CACOV...DOI :10.12659/AJCR.935263
Am J Case Rep 2022; 23:e935263
19 Jul 2022 : Case report
Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19DOI :10.12659/AJCR.936128
Am J Case Rep 2022; 23:e936128
23 Feb 2022 : Case report
Penile Necrosis Associated with Local Intravenous Injection of CocaineDOI :10.12659/AJCR.935250
Am J Case Rep 2022; 23:e935250