1/19. Reversible delayed leukoencephalopathy following intravenous heroin overdose.We present serial neuropsychological, magnetic resonance (MR) imaging and EEG changes in a case of widespread CNS myelinopathy due to intravenous heroin overdose complicated by a period of prolonged unconsciousness. Following recovery from the acute overdose, the subject had the delayed onset of akinetic mutism with urinary incontinence. Sequential formal neuro-psychological assessments over 9 months showed evolution from severe global cerebral dysfunction to moderate disturbance of frontal lobe function. Almost complete resolution of diffuse white matter signal changes, accompanied by the development of a degree of volume loss, was evident on serial MR imaging over the same period, and generalized arrhythmic delta-range slowing on the EEG evolved int o a near normal pattern.- - - - - - - - - - ranking = 1keywords = leukoencephalopathy, white matter, matter, white (Clic here for more details about this article) |
2/19. BIPLEDs in akinetic mutism caused by bilateral anterior cerebral artery infarction.INTRODUCTION: akinetic mutism is described as a result of many disorders. Bilateral infarction of the anterior cerebral artery (ACA) territory is reported rarely, however, often leading to akinetic mutism. CASE REPORT: We report a 70 year-old man with akinetic mutism due to bilateral ACA infarction. electroencephalography, 24h after admission, showed bilateral independent periodic lateralized epileptiform discharges (BIPLEDs) in the frontal region and diffuse theta and polymorphic delta activity. DISCUSSION: Postanoxic encephalopathy, central nervous system infection and chronic seizure disorders are the major causes of BIPLEDs. However, BIPLEDs may occur in bilateral ACA territory infarction.- - - - - - - - - - ranking = 0.00084895261735639keywords = central nervous system, nervous system (Clic here for more details about this article) |
3/19. akinetic mutism caused by bilateral infiltration of the fornix in a patient with astrocytoma.In a 59-year-old female patient, a world health organization (WHO) grade II astrocytoma had been diagnosed 16 years ago, which finally progressed into WHO grade III. Several right frontal neurosurgical resections, local radiation and a local radioimplant had been applied. Despite this long record, she was reported alert with a Karnofsky index of 90% until admission. Within a few weeks she rapidly developed akinetic mutism. Upon admission, computed tomography (CT) scan showed a large cystic right frontal defect and a suggested small tumor recurrence. White matter of the frontal lobe appeared to be translucent and compatible with previous radiation. The severe mental changes were initially attributed to a delayed radiation encephalopathy. Neuropathologically, the white matter of the frontal lobe showed mild elevated cell density consistent with gliosis; however, a tumor recurrence invading the tip of the corpus callosum and invading the entire length both fornices appeared. From the neuropathological findings of massive local tumor recurrence in both fornices, together with the acute clinical onset, it seems unlikely that the sequel of radiotherapy caused akinetic mutism, but the symmetric and severe involvement of the limbic system. We conclude that the rapid progression from a state of alertness to a full clinical picture of akinetic mutism was because of infiltration of both fornices.- - - - - - - - - - ranking = 0.0017704847545761keywords = matter, white (Clic here for more details about this article) |
4/19. adult "failure-to-thrive" syndrome.The analogy between the "failure-to-thrive" syndrome of childhood and a symptom complex seen in adult neurology is described. Adults presenting with a variety of central nervous system diseases occasionally seem to follow an unusual stereotyped course resulting in intractable weight loss, wide variations in temperature, and a tendency to intractable decubitus ulcerations in a setting of decreased levels of consciousness. Sudden death occurs unexpectedly. This syndrome can be observed following cerebral thrombosis, traumatic encephalopathy, degenerative central nervous system disorders, and encephalitis. The pathophysiology is thought to result from the random aggregate of lesions rather than a verifiable discrete hypothalamic deficit.- - - - - - - - - - ranking = 0.0017338049925938keywords = central nervous system, nervous system, childhood (Clic here for more details about this article) |
5/19. Leukoencephalopathy induced by tegafur: serial studies of somatosensory evoked potentials and cerebrospinal fluid.A case of leukoencephalopathy induced by tegafur, an antineoplastic derivative of 5-FU, is reported. The patient received 600 mg of tegafur p.o. for 16 days before excision of rectal cancer. After the operation, gait disturbance and mental abnormalities appeared. He became akinetic and mute within a few days following readministration of tegafur. Serial studies of brain CT, somatosensory evoked potentials (SEP) were made, and myelin basic proteins (MBP) in the cerebrospinal fluid were measured. The level of MBP was about twice the normal value and the central conduction time (CCT) of SEP was prolonged at admission. The value of MBP and CCT improved with recovery from akinetic mutism.- - - - - - - - - - ranking = 0.24875904945186keywords = leukoencephalopathy (Clic here for more details about this article) |
6/19. frontal lobe and cingulate cortical metabolic dysfunction in acquired akinetic mutism: a PET study of the interval form of carbon monoxide poisoning.A middle-aged man suffering from acute carbon monoxide intoxication was clinically assessed to be in an akinetic and mute state. In order to elucidate regional cerebral disturbances, brain metabolism was investigated with fluoro-deoxyglucose positron emission tomography ((18)FDG-PET) 5.5 months after intoxication. Significantly reduced metabolic rates of glucose were revealed in selected brain regions, especially in both the frontal and anterior cingulate cortices, as well as in the subcortical white matter. Frontal and cingulate cortices showed a preserved metabolism of 35-53%, whereas the regional glucose consumption in cerebral white matter was reduced by more than 70%. In contrast, other areas of the brain such as the sensory-motor cortex, parts of the temporal lobes, basal ganglia and brainstem disclosed normal metabolic values. This lesion topography is discussed in relation to the development of akinetic mutism in the present case and in comparison with recent reports on the topic. Considering a plausible pathophysiology, akinetic mutism appears to be based on a different structural neuropathology when compared with the locked-in syndrome and the vegetative state. It is suggested that akinetic mutism is regarded as a specific condition characterized by injury of the frontal neuronal systems which promote executive functions.- - - - - - - - - - ranking = 0.0099276043851259keywords = white matter, matter, white (Clic here for more details about this article) |
7/19. MRI findings from a case of fulminating adult-onset measles encephalitis.We report a rare case of fulminating adult-onset measles encephalitis. A 34-year-old man developed a comatose state after measles eruptions and ultimately akinetic mutism. Titers of anti-measles IgM antibodies were elevated in both serum and cerebrospinal fluid. Brain magnetic resonance imaging (MRI) 3 months after onset revealed widespread hyperintense lesions in the periventricular white matter and marginal hyperintense lesions in the brainstem on fluid-attenuated inversion recovery and diffusion-weighted images. The marginal lesions in the brainstem are similar to subpial demyelinating lesions seen in postinfectious encephalomyelitis. This case of encephalitis may be related to an autoimmune-mediated process triggered by measles infection.- - - - - - - - - - ranking = 0.0049638021925629keywords = white matter, matter, white (Clic here for more details about this article) |
8/19. Bithalamic lesions of butane encephalopathy.Butane inhalation can cause serious medical complications and is particularly toxic to the nervous system. This is a report of an acutely encephalopathic youth with prominent abulia. MRI revealed severe bithalamic injury attributed to butane toxicity. Clinical issues, including particular radiologic findings, related to butane inhalation are reviewed.- - - - - - - - - - ranking = 0.00023658006411551keywords = nervous system (Clic here for more details about this article) |
9/19. encephalitis lethargica-like illness in a five-year-old.A five-year-old boy presented with an encephalitis lethargica-like illness, characterised by somnolence, mutism and Parkinsonian rigidity two weeks after an acute exanthem. Investigation revealed increased serum measles antibody titre. He made a complete recovery. encephalitis lethargica associated with Parkinsonism in childhood is rare and usually carries a poor prognosis.- - - - - - - - - - ranking = 3.5899757880981E-5keywords = childhood (Clic here for more details about this article) |
10/19. akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin b chemoprophylaxis. A positron emission tomographic and neuropathologic study.We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin b chemoprophylaxis. A trial of high-dose bromocriptine did not stimulate purposeful verbal or motor activity. fluorine 18-fluorodeoxyglucose/positron emission tomographic studies, performed before and during bromocriptine therapy, demonstrated cerebral hypometabolism and treatment-related decreases in regional cerebral blood volume. We conclude that whole-brain or total-body irradiation may increase blood-brain barrier permeability to polyene antibiotics, and that high-dose therapy with dopamine agonists is unlikely to benefit patients with akinetic mutism due to diffuse white-matter lesions.- - - - - - - - - - ranking = 0.24967556614708keywords = leukoencephalopathy, matter, white (Clic here for more details about this article) |
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