However, in this case, the affected individual is alert and heshe may make active eye movements in response to a person or sound. 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. Bilateral lesions to the acc may be causallyassociated with akinetic mutism, where patientsare unable to voluntarily initiate responses. Cyclosporinassociated akinetic mutism and extrapyramidal syndrome after liver transplantation. Hysterical mutism is usually complete, that is, the patient does not utter a single word. Akinetic mutism is an unusual mental state in which the patient is mute, generally unresponsive and unwilling to perform even simple motor activity. It has been described in a number of neurological conditions including trauma, malignancy and cerebral ischaemia. After treatment of the aneurysm, the patients lay immobile, mute and were unresponsive to commands. Pdf akinetic mutism is a rare neurological condition characterised by the lack of verbal and motor output in the presence of preserved alertness.
Akinetic mutism has a number of causes with varied pathology and is characterized by a marked reduction in motor function, including facial expression, gestures. Akinetic mutism following stroke request pdf researchgate. In am the patient is alert, conscious of surroundings and able to see and. T1 reversible akinetic mutism possibly induced by baclofen. Pdf file of the complete article 977k, or click on a page image below to browse page by page. Diagnostic criteria creutzfeldtjakob disease, classic. However, in this case, the affected individual is alert and heshe may make active eye movements in response to a. 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.
Mutism definition and meaning collins english dictionary. During the eight years of her illness she had several periods of akinetic or trancelike mutism in which she was essentially inert with her eyes open and. More detailed information about the symptoms, causes, and treatments of akinetic mutism is available below. This uncommon disorder has since been described in. Akinetic mutism could be explained by damage to the frontal lobe and or interruption of the complex frontal subcortical circuits. Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Akinetic mutism medigoo health medical tests medical. Three cases of bilateral anterior cerebral artery occlusion are presented with akinetic mutism. Bilateral injury of the frontosubcortical circuit is a possible pathogenetic mechanism of am. Updated clinical diagnostic criteria for sporadic creutzfeldtjakob disease. Unique presentation of akinetic mutism and coexisting. Akinetic mutism article about akinetic mutism by the free. Akinetic mutism am is defined as a form of stupor, characterised by severe apathy. Computed tomographic findings in akinetic mutism jama.
The icd10cm alphabetical index is designed to allow medical coders to look up various medical terms and connect them with the appropriate icd codes. A child or adult with selective mutism does not refuse or choose not to. Reversible akinetic mutism after aneurysmal subarachnoid. 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. 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. In which patient lack some motor activities like movement of facial muscles to show facial expressions and gestures. Akinetic mutism as a classification criterion for the. However, their eyes may follow their observer or be diverted by sound. Mutism the inability or refusal to speak that takes place in the absence of any organic lesions of the vocal apparatus. Akinetic mutism is often due to damage to the frontal lobes of the brain. Akinetic mutism is a disorder of consciousness characterized by. Braininjured children who progress from coma to a sleeplike state of akinetic mutism are often misinterpreted by their parents as having improved. Akinetic mutism is a neurological disorder characterised by diminished voluntary movement, speech and thought, without disturbance of arousal.
Bilateral paramedian thalamic infarction is an uncommon but recognised cause of akinetic mutism and clonic perseveration. We discuss this rare condition and the unusual unilateral. Patients may open their eyes and seem alert, and brief movement. Akinetic mutism is characterized by an individuals inability to move or speak.
Jul 28, 2016 akinetic mutism after subarachnoid haemorrhage 1. These children may develop oppositional behaviors out of a combination of frustration, their own inability to make sense of their mutism, and other people pressuring them to speak. 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. Mutism not only persists in these children, but also is negatively reinforced. Akinetic mutism can occur in the frontal region of the brain and occurs because of bilateral. 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. Akinetic seizure definition of akinetic seizure by.
Akinetic mutism article about akinetic mutism by the. Akinetic mutism and bilateral anterior cerebral artery. Unique presentation of akinetic mutism and coexisting thyroid. Stephen ashwal, in swaimans pediatric neurology sixth edition, 2017. Akinetic mutism definition of akinetic mutism by the. Lack of initiative in thought, speech, physical action and affective emotion reluctance to perform simple motor activities, however has ability to do so. A state in which a person is unable to speak mute or move akinetic. Akinetic mutism definition of akinetic mutism by medical. Relief of akinetic mutism from obstructive hydrocephalus.
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. Electroencephalography showed a diffusely slow background with intermittent generalized sharp wave discharges. Patients lack most motor functions such as speech, facial expressions, and gestures, but demonstrate apparent alertness. Neth j crit care volume 24 no 3 may 2016 29 netherlands journal of critical care submitted october 2015. 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. Recovery of akinetic mutism and injured prefrontocaudate. It has been reported in children with brain tumors, bacterial and viral cns infections, hydrocephalus, and occasionally as a postoperative phenomenon.
Clinical and experimental aspects of akinetic mutism. Aan members 800 8791960 or 612 9286000 international nonaan member subscribers 800 6383030 or 301 2232300 option 3, select 1 international. Diagnostic criteria creutzfeldtjakob disease, classic cjd. 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. Akinetic mutism after internal watershed infarction. Akinetic mutism is a medical term describing patients tending neither to move akinesia nor. Reversible akinetic mutism possibly induced by baclofen. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Akinetic mutism following stroke journal of clinical neuroscience. Akinetic mutism disorder characterized by a silent and inert state without voluntary motor activity despite preserved sensorimotor pathways and vigilance. Akinetic mutismnot coma age and ageing oxford academic. Akinetic mutism is a rare condition consisting of pathologically slowed or nearly absent bodily movement, accompanied by a similar loss of speech.
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. As a result of the scarcity and, often, inaccuracy of information in the. 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. 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 may be seen in motor aphasia f, patients with aphasia, particularly those with motor aphasia, use the wrong word, invent new words, or distort the phonetic. It often occurs after brain injury or as a symptom of other diseases. 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. Mutism is also found in patients suffering from schizophrenia and hysteria. It is a term that is used medically and is believed to be associated with the mental state of an affected individual. 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. Akinetic mutism case reports and aetiological considerations. Question the abbreviated term adhd denotes the condition commonly known as. Accepted march 2016 c a s e r e p o r t lack of motivation.
More detailed information about the symptoms, causes, and treatments of akinetic mutism is available below symptoms of akinetic mutism. 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. Brust, angel chamorro, in stroke sixth edition, 2016. Report of a who consultation, february 911, 1998, geneva, switzerland. With a report of the associated disturbance of brain potentials. Schoonman1 departments of 1 neurology, 2 intensive care. 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. Akineticrigid syndrome definition of akineticrigid.
Provided to youtube by cdbaby akinetic mutism slaughtermouse within i find. Akinetic mutism am is a rare neurological disorder of impaired initiation and motivation for behavior. Akinetic mutism from frontal lobe damage responding to. N2 a 76yearold man developed akinetic mutism after 3 days of receiving lowdosage baclofen. Akinetic mutism also occurs with lesions of the anteromedial frontal lobes, including infarction. Mutism article about mutism by the free dictionary. 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. Cyclosporinassociated akinetic mutism and extrapyramidal. 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. Slideshow 17 everyday ways to ease depression see slideshow. 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. 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 seizure definition of akinetic seizure by medical. Following the landmark case report of cairns et al.
Akinetic mutism am is defined as a complete absence of spontaneous behavior and speech. Stupor and coma are clinical states in which patients have impaired responsiveness or are unresponsive to external stimulation and are either difficult to arouse or are unarousable. 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 dopaminereward system in the. Akinetic mutism can be caused by a variety of things. Akinetic mutism symptoms, diagnosis, treatments and causes. 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. Clonic perseveration is an unusual but well recognised sign which may be mistaken for seizures. In the two cases, vasospasm could not be demonstrated by imaging studies throughout the clinical course. The aim of this study was to delimit the symptom of akinetic mutism in patients with. 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 has been anatomically divided into two formsthe mesencephalic form and the frontal form. Akinetic mutism after baclofen annals of internal medicine. It is a serious sequela of brain injury in terms of absolute need for a caregiver and loss of working ability. There are 0 terms under the parent term akinetic mutism in the icd10cm alphabetical index. Baclofen, a derivative of the inhibitory neurotransmitter gammaaminobutyric acid, is useful for reducing frequency and severity of flexor or extensor muscle spasms 1. In children with akinetic mutism caused by extensive destruction of the cerebral gray matter, the computed tomographic scan may demonstrate the irreversible nature of the pathologic changes. However, alertness, visual fixation, motor and sensory functions and some fundamental cognitive abilities are preserved1,2. Posts about akinetic mutism written by angelodealwis. A spectrum of motivational impairment has abulia at one end and akinetic mutism at the other.
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. On the pathophysiology and treatment of akinetic mutism. The term was initially used in 1941 by cairns et al in their presentation of a patient with an epidermoid cyst of the third ventricle. Cdcs diagnostic criteria for creutzfeldtjakob disease cjd, 2018 adapted from. 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. Pdf akinetic mutism am is a rare neurological disorder characterized by the presence of an intact level of consciousness and sensorimotor capacity. Schoonman1 departments of 1 neurology, 2 intensive. Akinetic mutism was first described in 1941 as a mental state where patients lack the ability to move or speak. Akinetic mutism is not a state like paralysis, in akinetic mutism it all depends upon the patients will to move and speak. The anatomical distribution of the infarction in these patients combined with cases in the literature suggests that this syndrome can have a localizing value for the clinician. Akinetic mutism is a medical term describing patients tending neither to move nor speak. Pdf on the pathophysiology and treatment of akinetic mutism. The anterior cingulate cortex, akinetic mutism, and human.
The ability to speak disappears suddenly and returns just as unexpectedly. Akinetic mutism akinetic mutism caused by tumors, tbi, anoxia, encephalitis, etc total absence of spontaneous behavior and speech, however can visually track objects abulia. 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. It usually starts during childhood and, if left untreated, can persist into adulthood. Differentiating akinetic mutism from coma is difficult. Akinetic mutism definition, symptoms, causes, treatment. Patients with am maintain an intact level of consciousness. Akinetic mutism related symptoms are more likely resemble the symptoms of shock. Akinetic mutism and bilateral anterior cerebral artery occlusion.
1228 977 610 1305 312 1232 1246 1643 1633 864 579 1495 766 1045 1473 147 816 342 19 1191 1329 872 275 1403 1350 1230 436 1242 652 851 195 637