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. 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. We studied a 70yearold woman with a unique combination of hyperkinesia and mutism. The first one is the akinetic mutism, clinically related to a lesion of the. They describe the clinical features as mutism accompanied with limited movement in patients who have their eyes open, will track visual stimuli, and withdraw from painful stimuli. Bilateral lesions to the acc may be causallyassociated with akinetic mutism, where patientsare unable to voluntarily initiate responses. Bilateral paramedian thalamic infarction is an uncommon but recognised cause of akinetic mutism and clonic perseveration. 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.
Based on nonhuman primate tracer studies, ventral pallidal lesions should disrupt the anterior cingulate frontalsubcortical circuit. An acute brainstem lesion seen on mri may explain this patients akinetic mutism. Episodically remitting akinetic mutism following subarachnoid hemorrhage article pdf available in journal of neuropsychiatry 111. Akinetic mutism can be caused by a variety of things. 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. Selective mutism an integrated treatment approach by robert l. Both findings were specific for these syndromes compared with brain lesions causing similar physical impairments but wit hout disordered. 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. Following the landmark case report of cairns et al. Lack of initiative in thought, speech, physical action and affective emotion reluctance to perform simple motor activities, however has ability to do so.
Apr 07, 20 an inexistence or major decrease of deliberate motions and conversation, even though the person does pay attention to eye motions. Theyll track motion with their eyes, and change position occasionally, but nothing more. Akinetic mutism is a rare condition consisting of pathologically slowed or nearly absent bodily movement, accompanied by a similar loss of speech. Ddm are not classified as disorders within dsm5, and it remains unclear if they are. Pdf persistent vegetative state, akinetic mutism and. Persistent vegetative state, akinetic mutism and consciousness. Akinetic mutism definition, a state of apparent alertness with normal eye movements but no speech or other voluntary motion, usually due to a stroke. 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.
The end state is akinetic mutism, a kind of waking coma. Akinetic mutism symptoms, diagnosis, treatments and causes. Akinetic mutism is a medical term describing patients tending neither to move akinesia nor. 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. Since the initial description of akinetic mutism in 1931, lesions in a variety of locations have been associated with this and other disorders of diminished motivation. Akinetic mutism definition of akinetic mutism by medical. Akinetic mutism from frontal lobe damage responding to. 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.
Treatment of akinetic mutism with intramuscular olanzapine. It often occurs after brain injury or as a symptom of other diseases. In fact, what clearly merge from another important study the rostral medial prefrontal. Ct demonstrated bilateral calcifications in the basal ganglia, and mri indicated bilateral watershed infarcts. Thalamic lesions combine the amnesia of medial limbic dysfunction with. Treating organic abulia with bromocriptine and lisuride. Akinetic mutism am is a rare neurological disorder characterized by the. A bilateral damage to the frontal lobe of the brain which renders the patient unable to move the akinesia causes the akinetic mutism. There are 0 terms under the parent term akinetic mutism in the icd10cm alphabetical index. 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.
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 being preserved. Akinetic mutism definition of akinetic mutism by the free. The case study of a 53yearold male patient who developed akinetic mutism for a period of 7 months after a subarachnoid. It is a term that is used medically and is believed to be associated with the mental state of an affected individual. Akinetic mutism am is a rare neurological disorder characterized by the presence of an intact level of consciousness and sensorimotor capacity, but with a simultaneous decrease in goaldirected. We report on two cases of transient akinetic mutism after massive subarachnoid haemorrhage due to the rupture of an intracranial aneurysm of. Pdf episodically remitting akinetic mutism following. Neth j crit care volume 24 no 3 may 2016 29 netherlands journal of critical care submitted october 2015. Akinetic mutism is not a state like paralysis, in akinetic mutism it all depends upon the patients will to move and speak. Slideshow 17 everyday ways to ease depression see slideshow.
It usually starts during childhood and, if left untreated, can persist into adulthood. We discuss this rare condition and the unusual unilateral. Clonic perseveration is an unusual but well recognised sign which may be mistaken for seizures. One is related to the mesencephalic region and is described as apathetic akinetic mutism or somnolent mutism. Akinetic mutism related symptoms are more likely resemble the symptoms of shock. Summary three cases ofbilateral anterior cerebral artery occlusion are presented with akinetic mutism. On the pathophysiology and treatment of akinetic mutism. 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. Akinetic mutism akinetic mutism caused by tumors, tbi, anoxia, encephalitis, etc total absence of spontaneous behavior and speech, however can visually track objects abulia. Schum selective mutism is a uniquely challenging childhood communication disorder that demands a coordinated treatment approach. Pdf akinetic mutism following stroke nages nagaratnam.
Oct 25, 2015 provided to youtube by cdbaby akinetic mutism slaughtermouse within i find. A spectrum of motivational impairment has abulia at one end and akinetic mutism at the other. In which patient lack some motor activities like movement of facial muscles to show facial expressions and gestures. Accepted march 2016 c a s e r e p o r t lack of motivation. This type of mutism is caused by bilateral damage to the frontal lobe area of the brain which is responsible for arousal and motivation. Akinetic mutism is a rare neurological condition in which an affected individual does not move akinetic or talk mute despite being awake. Keywords akinetic mutism, abulia, subarachnoid haemorrhage, cingulate cortex abstract akinetic mutism is a rare neurological condition characterised by the lack of verbal and motor output in the presence of preserved alertness. All of the disease manifestations can be explained by damage to the frontal lobe or interruption. Locked in syndrome nord national organization for rare. Individuals with akinetic mutism have normal sleepwake cycles, but when awake lie still and unresponsive, neither moving nor talking. Akinetic mutism is the outcome of severe frontal lobe damage in which the pattern of inhibitory control is one of increasing passivity and gradually reducing speech and motion. The neuropsychiatric spectrum of motivational disorders. Request pdf on aug 1, 2000, onofre combarros and others published akinetic mutism from frontal lobe damage responding to levodopa find, read and. The icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes.
This person may be quite capable of speech but is unable to speak in certain environments, or in front of some people. Reversible akinetic mutism after aneurysmal subarachnoid haemorrhage in the territory of the anterior cerebral artery without permanent ischaemic damage to anterior cingulate gyri created date 6232016 12. Relevant terms include anhedonia, apathy, akinetic mutism, abulia, avolition. Selective mutism in children selective mutism is a social anxiety disorder where an individual experiences fear and apprehension when in social situations. Prolonged akinetic mutism due to multiple sclerosis the. Review cjd mimics and chameleons practical neurology. A patient with akinetic mutism shows symptoms that are similar to other recognized conditions, such as catatonia in psychiatric patients and lockedin state in paralysis patients, but it is a distinct medical condition.
Freemon fromthe departmentofneurology, marquette schoolofmedicine, milwaukee, wisconsin, u. Learn vocabulary, terms, and more with flashcards, games, and other study tools. With a report of the associated disturbance of brain potentials. This is an appraisal of the varied clinical presentation and the neural substrate for akinetic mutism following stroke. Akinetic mutism is a medical term describing patients tending neither to move akinesia nor speak mutism. Akinetic mutisma serious complication to tacrolimusbased. The type of mutism which is caused by physical impairment of brain or speech motor system due to a multitude of reasons including birth defects, accidents, head or neck injuries, strokes or parkinsons disease. Relief of akinetic mutism from obstructive hydrocephalus. Pdf on the pathophysiology and treatment of akinetic mutism. 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. Unique presentation of akinetic mutism and coexisting thyroid. Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Speechlanguage pathologists are in an excellent position to coordinate intervention among family, classroom teachers, and other clinicians. May, 2020 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.
Schoonman1 departments of 1 neurology, 2 intensive care. Lesion locations causing alien limb fell within a separate network, defined by connectivity to the precuneus. It has been reported in children with brain tumors, bacterial and viral cns infections, hydrocephalus, and occasionally as. Akinetic mutism andbilateral anterior cerebral artery occlusion frankr. 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. Posts about akinetic mutism written by angelodealwis. Akinetic mutism following unilateral anterior cerebral artery. Akinetic mutism article about akinetic mutism by the free. More detailed information about the symptoms, causes, and treatments of akinetic mutism is available below. These findings differed from akinetic mutism because there was continuous bilateral ballism and dystoniahence the term hyperkinetic mutism. Akinetic mutism was first described in 1941 as a mental state where patients lack the ability to move or speak.
Akinetic mutism may result from anterior cingulate lesions or a disconnection of the limbic connections projecting from the cingulate through subcortical circuits. Akinetic mutismnot coma age and ageing oxford academic. Akinetic mutism as a classification criterion for the. Mutism definition and meaning collins english dictionary. Differentiating akinetic mutism from coma is difficult.
However, in this case, the affected individual is alert and heshe may make active eye movements in response to a person or sound. There are reports of successful treatment of akinetic mutism, the most severe form of abulia, with bromocriptine. 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. 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. It has been described in a number of neurological conditions including trauma, malignancy and cerebral ischaemia. The absence of internally guided behavior allows attention to be passively drawn to any environmental stimulus that the patient is exposed to. They lie still in a hospital bed, often have eyes open but not tracking a face moving across the visual field. Akinetic mutism disorder characterized by a silent and inert state without voluntary motor activity despite preserved sensorimotor pathways and vigilance. Akinetic mutism medigoo health medical tests medical. Abulia refers to an impairment of will, or the inability to initiate behaviour and action. The aim of this study was to delimit the symptom of akinetic mutism.
This is a descriptive study of eight selected patients with akinetic mutism following infarctionhaemorrhage in different regions of the brain with characteristic. Reversible akinetic mutism after aneurysmal subarachnoid. Akinetic mutism definition, symptoms, causes, treatment. Akinetic mutism after right internal watershed infarction lim y c, ding c s l, kong k h abstract we describe a 72 year old man who developed akinetic mutism following a cerebrovascular accident involving his right internal watershed area and responded well to dopaminergic agonists. Jul 28, 2016 akinetic mutism after subarachnoid haemorrhage 1. Provided to youtube by cdbaby akinetic mutism slaughtermouse within i find. The other is known as hyper pathic akinetic mutism and is associated. Brust, angel chamorro, in stroke sixth edition, 2016. However, alertness, visual fixation, motor and sensory functions and some fundamental cognitive abilities are preserved1,2. In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. Akinetic mutism multiple choice questions mcqs in psychiatry. Akinetic mutism following stroke request pdf researchgate. Akinetic mutism andbilateral anterior cerebral artery.
Akinetic mutism case reports and aetiological considerations. Four case studies are presented describing the successful treatment of abulia at a lesser severity than akinetic mutism with bromocriptine. Akinetic mutism is characterized by an individuals inability to move or speak. Selective mutism is a severe anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often. Pdf akinetic mutism am is a rare neurological disorder characterized by the. A state in which a person is unable to speak mute or move akinetic. Frontalsubcortical circuits and human behavior department of. Aan members 800 8791960 or 612 9286000 international nonaan member subscribers 800 6383030 or 301 2232300 option 3, select 1 international. Cerebral function in coma, vegetative state, minimally. The anterior cingulate cortex, akinetic mutism, and human.
Disorders of diminished motivation ddmincluding apathy, abulia, and akinetic mutism are characterized by impairment in goaldirected behavior, thought, and emotion. Unique presentation of akinetic mutism and coexisting. Akinetic mutism after internal watershed infarction. Akinetic mutism am is a rare neurological disorder characterized by the presence of an intact level of consciousness and sensorimotor capacity, but with a. Theanatomical distribution ofthe infarction in these patients combinedwith. A child or adult with selective mutism does not refuse or choose not to. Akinetic mutism is an unusual mental state in which the patient is mute, generally unresponsive and unwilling to perform even simple motor activity. Akinetic mutism has been anatomically divided into two formsthe mesencephalic form and the frontal form. Akinetic mutism is often due to damage to the frontal lobes of the brain. 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. Are always new words invented by patients with schizophrenia f, neologisms may be new words that are constructed by the patient or ordinary words that are used in a new way.