The authors report a case of rostral mesencephalic dysfunction due to obstructive hydrocephalus secondary to periaqueductal tumor who suffered multiple shunt failures and shunt revision. This patient presented with clinical syndromes, including akinetic mutism and diencephalic autonomic epilepsy. He had computed tomography(CT) and magnetic resonance(MR) findings of dilatation of ventricular system with periaqueductal tumor. The anatomical substrates of clinical findings are reviewed. A discussion of the probable mechanism proposes that dilatation of 3rd ventricle and rostral aqueduct sufficiently explains the entire syndrome.
Akinetic Mutism ; Dilatation ; Epilepsy ; Humans ; Hydrocephalus* ; Mesencephalon*

The authors report one case of akinetic mutism with obstructive hydrocephalus. The patient suffered from multiple shunt failures and shunt revision. After multiple shunt revision, the patient fell into an akinetic-mute state. She appeared awake but was no response to painful somatosensory, loud auditory or threatening visual stimuli and she required total nursing care. This behavioral syndrome was no response to shunt revision but we were able to successfully treat a case of akinetic mutism after combination theraphy of Bromocryptine and Ephedrine.
Akinetic Mutism* ; Bromocriptine* ; Ephedrine* ; Humans ; Hydrocephalus ; Nursing Care

Akinetic mutism is a syndrome caused by various etiologies, and characterized by silent immobility and preserved alertness. The repetitive ventriculoperitoneal shunt for the recurrent hydrocephalus can be a forerunner of that. We present a man with akinetic mutism following two times of ventriculoperitoneal shunt revision. Akinetic mutism of the patient may be caused by the damage on the ascending dopaminergic projections. Symptoms were not alleviated by the normalization of ventricular size but by a large dose of bromocriptine.
Akinetic Mutism* ; Bromocriptine ; Cerebral Ventricles* ; Humans ; Hydrocephalus ; Ventriculoperitoneal Shunt

Cerebellar mutism (CM) is a rare neurological condition characterized by lack of speech due to cerebellar lesions. CM is often reported in children. We describe a rare case of CM after spontaneous cerebellar hemorrhage. The patient showed mutism, irritability, decreased spontaneous movements and oropharyngeal apraxia. Diffusion tensor imaging revealed significant volume reduction of medial frontal projection fibers from the corpus callosum. In Tracts Constrained by UnderLying Anatomy (TRACULA) analysis, forceps major and minor and bilateral cingulum-angular bundles were not visualized. Cerebello-frontal pathway reconstructed from the FMRIB Software Library showed continuity of fibers, with decreased number of fibers on qualitative analysis. These results suggest that cerebello-frontal disconnection may be a neuroanatomical mechanism of CM. Damage of brain network between occipital lobe, cingulate and cerebellum caused by hemorrhage may also have role in the mechanism of CM in our case.
Akinetic Mutism ; Apraxias ; Brain ; Cerebellum ; Child ; Corpus Callosum ; Diffusion Tensor Imaging ; Hemorrhage ; Humans ; Mutism* ; Occipital Lobe ; Stroke* ; Surgical Instruments

A patient who had akinetic mutism was mistaken for a psychologic disorder or true coma. We experienced a case of reversible akinetic mutism and paraplegia for 5 hours after general anesthesia in a 28-year-old female who underwent debridement of chemical burn-induced skin necrosis on the left leg.
Adult ; Akinetic Mutism* ; Anesthesia, General* ; Coma ; Debridement ; Female ; Humans ; Leg ; Necrosis ; Paraplegia ; Skin

A patient who had akinetic mutism was mistaken for a psychologic disorder or true coma. We experienced a case of reversible akinetic mutism and paraplegia for 5 hours after general anesthesia in a 28-year-old female who underwent debridement of chemical burn-induced skin necrosis on the left leg.
Adult ; Akinetic Mutism* ; Anesthesia, General* ; Coma ; Debridement ; Female ; Humans ; Leg ; Necrosis ; Paraplegia ; Skin

We experinced 2 cases of reversible leukoencephalopathy, caused by 5-Fluorouracil derivatives(carmoful), presenting as akinetic mutism. Each patient was diagnosed as colon cancer and stomach cancer respectively and received operations. Their outcome was good without metastatic evidences, and carmoful was started orally 400mg in 1 case and 600mg in the other. Their clinical pictures were akinetic mutism, one and two months after the administration of carmoful. There were no metastatic lesions in the brain CT but bilaterally symmetric diffuse low densities of cerebral whites matter, predominantly in the frontal area, were noted. Carmoful was discontinued and replaced by conservative treatment. One and two months later, their clinical symptoms improved without specific treatment. Follow up brain CT was done in case 2, which revealed attenuation of the previous low densities.
Akinetic Mutism* ; Brain ; Colonic Neoplasms ; Fluorouracil* ; Follow-Up Studies ; Humans ; Leukoencephalopathies* ; Stomach Neoplasms

A 42-year-old man with left posterior inferior cerebellar artery (PICA) infarction presented with akinetic mutism and cognitive impairment. Initially he suffered from akinetic mutism and MRI-documented infarction in the distribution of the left PICA. Twelve days later he developed cognitive impairment. Neuropsychological tests were performed, with the results corrected for age and education being compared with published Korean norms. Impaired performances were evident on executive function testing, with difficulties in planning, abstract reasoning, set-shifting, and perseveration. Akinetic mutism and cognitive-affective syndrome may be a manifestation of unilateral PICA infarction.
Adult ; Akinetic Mutism* ; Arteries ; Education ; Executive Function ; Humans ; Infarction* ; Neuropsychological Tests ; Pica*

The 'Locked-In' syndrome, first described by plum and posner in 1966 as a brain stem stroke due to bilateral basis pontis infarction with limb and psedobullar paralysis, but with unimpaired consciousness communicating intelligently by vertical eye movement had become contradistinctive to the state of 'akinetic mutism', coined by Cairns er al in 1941, which can be described as unresponsive patients who appear to be awake but are not aware of the environment, lacking response to command but having the ability to move his extremities. Recently there has been interest in this disorder, both pathologically and clinically with regard to its anatomical location of the lesion at various levels of the brain stem and its clinical characteristics including the ocular signs, the electroencephalogram, the outcome of the disorder etc., respectively. We have experienced a case of brain stem stroke that was compatible with the 'Locked-In' syndrome, determined by clinical evaluation alone. Postmortem examination was not granted. A brief review of the literatures is added and the difference between the 'Locked-In' syndrome and cliassical akinetic mutism is discussed, also stressing differentiation of the Locked-In patient from the comatose patient.
Akinetic Mutism ; Autopsy ; Brain Stem ; Coma ; Consciousness ; Electroencephalography ; Extremities ; Eye Movements ; Financing, Organized ; Humans ; Infarction ; Numismatics ; Paralysis ; Prunus domestica ; Stroke

BACKGROUND: Oriental medicines have been associated with severe psychiatric, neurological, and other adverse medical events. These medicines occasionally cause a typical reversible toxic encephalopathy, but most such cases are not recognized because these adverse events are complex and are associated with other systemic signs and symptoms. CASE REPORT: We describe a married couple with rapid progressive cognitive impairment and akinetic mutism after taking the same oriental medicines on the same day. Brain magnetic resonance images of the couple showed typical leukoencephalopathy in the periventricular white matter and basal ganglia regions, bilaterally. CONCLUSIONS: The development of neurobehavioral symptoms and toxic leukoencephalopathy in both patients following the ingestion of oriental medicines is suggestive of a cause-and-effect association, although such a relationship needs to be verified.
Akinetic Mutism ; Basal Ganglia ; Brain ; Eating ; Humans ; Leukoencephalopathies ; Magnetic Resonance Spectroscopy ; Medicine, East Asian Traditional ; Neurotoxicity Syndromes