Cases reported "Akinetic Mutism"

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11/22. Consciousness and altered consciousness.

    The notion of consciousness in the English scientific literature denotes a global ability to consciously perform elementary and intellectual tasks, to reason, plan, judge and retrieve information as well as the awareness of these functions belonging to the self, that is, being self-aware. consciousness can also be defined as continuous awareness of the external and internal environment, of the past and the present. The meaning of consciousness is different in various languages, but it invariably includes, the conscious person is capable to learn, retrieve and use information. Disturbance or loss of consciousness in the Hungarian medical language indicates decreased alertness or arousability rather than the impairment of the complex mental ability. awareness denotes the spiritual process of perception and analysis of stimuli from the inner and external world. Alertness is a prerequisite of awareness. Clinical observations suggest that the lesions of specific structures of the brain may lead to specific malfunction of consciousness, therefore, consciousness must be the product of neural activity. "Higher functions" of human mental ability have been ascribed to the prefrontal and parietal association cortices. The paleocerebrum, limbic system and their connections have been considered to be the center of emotions, feelings, attention, motivation and autonomic functions. Recent evidence indicates that these phylogenetically ancient structures play an important role in the processes of acquiring, storing and retrieving information. The hippocampus has a key role in regulating memory, learning, emotion and motivation. Impaired consciousness in the neurological practice is classified based on tests for conscious behavior and by analyzing the following responses: 1. elementary reactions to sensory stimuli--these are impaired in hypnoid unconsciousness, 2. intellectual reactions to cognitive stimuli--these indicate the impairment of cognitive contents in non-hypnoid unconsciousness. Obviously, disturbance of elementary reactions related to alertness and disturbance of intellectual performance overlap. In conditions with reduced ability to react to or to perceive external stimuli the cognitive disturbance of consciousness cannot fully be explored.
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12/22. 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.
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13/22. akinetic mutism: pharmacologic probe of the dopaminergic mesencephalofrontal activating system.

    Four children who exhibited akinetic mutism during the course of their neurologic diseases were treated with bromocriptine. Reversal of the akinetic mute states was evident in all patients. Pathways of the dopaminergic neurons are reviewed and a clinically useful mechanism which causes akinetic mutism is postulated.
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14/22. coma vigil masquerading as psychiatric illness.

    A patient is described who had the hyperpathic variety of akinetic mutism (coma vigil), which was mistaken for a dissociative state. The case discussion emphasizes the importance of differentiating neuropsychiatric syndromes from those which are purely psychiatric in nature in order that appropriate treatment may be given.
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15/22. Computed tomographic findings in akinetic mutism.

    Brain-injured children who progress from coma to a sleeplike state of akinetic mutism are often misinterpreted by their parents as having improved. 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.
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16/22. Neuropathology in seven cases of locked-in syndrome.

    The neuropathology of 7 cases of the locked-in syndrome has been reviewed and compared with 3 cases of akinetic mutism, all of them occurring after brainstem vascular disease (9 infarctions, 1 hematoma). Including other published cases of verified locked-in syndrome, the extent of lesions has been studied in order to understand, among other symptoms, the preservation of consciousness, voluntary eye movements, auditory comprehension and vital functions. It is concluded that, at the time of autopsy, although most of the clinical signs can be explained by the pathological findings, it is not yet possible to individualize specific brainstem lesions responsible for this syndrome.
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ranking = 0.0054189371949513
keywords = consciousness
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17/22. Bilateral symmetrical softening of the thalamus.

    The clinical and pathological data of a 48 year old patient who survived 40 days are reported. Her disturbance of consciousness corresponded to an apallic syndrome, which 12 days later bacame akinetic mutism. Symmetrical softening involving the medial thalamic nuclei from the plane of the corpora mamillaria to the red nuclei was found. The ischemic lesion might be explained by transient circulatory collapse combined with hypoplasia of the vertebrobasialr arteries. On the EEG slight irregular alpha activity was recorded (alpha coma) and external stimuli elicited theta-delta waves (paradox activation). A survey of the literature of akinetic mutism is included and the correlation between non-hypnoid unconsciousness and EEG is discussed.
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ranking = 0.47290531402524
keywords = unconsciousness, consciousness
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18/22. Multiple system degeneration and involving thalamus, reticular formation, pallido-nigral, pallido-luysian and dentato-rubral systems. A case report.

    An autopsy case of multiple system degeneration is characterized by the following; (1) progressive dementia and abnormal sleep patterns, followed by Parkinsonian symptoms with terminal akinetic mutism; (2) severe symmetrical degeneration in the thalamus, particularly nucl. medialis thalami, the reticular formation of the brain stem, also the pallidonigral, pallido-Luysian and dentato-rubral systems. As far as we known, there is no case in the literature, of combined system degeneration, which shows such a wide anatomical range of lesions as the present one. Clinico-pathological correlation between dementia and degeneration of the thalamus, and between abnormal sleep-consciousness mechanism and degeneration of the reticular formation are discussed. The extrapyramidal symptoms are discussed from the clinico-pathological aspect. In addition, peculiar eosinophilic bodies are described, which were most frequently found in the putamen.
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ranking = 0.0054189371949513
keywords = consciousness
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19/22. encephalomyelitis subsequent to mycoplasma infection with elevated serum anti-Gal C antibody.

    We report a 7-year-old girl with acute disseminated encephalomyelitis subsequent to a mycoplasma infection. She manifested a prolonged state of akinetic mutism, during which EEG revealed well-synchronized spindles. Four months later, she regained consciousness, with no mental deficit, but complete flaccid quadriplegia persisted and magnetic resonance imaging disclosed extensive destruction of the spinal cord. Antibody against galactocerebroside was detected in her serum during the acute phase. The anti-Gal C antibody is suggested to be involved in the pathogenesis of immune-mediated demyelinating diseases in the central nervous system subsequent to mycoplasma infections.
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ranking = 0.0055212329892187
keywords = consciousness, state
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20/22. akinetic mutism due to diphenylhydantoin toxicity.

    akinetic mutism (AM) is a rare, specific, unconscious state. An AM patient seems to be awake, lacks mental activity, is unable to speak, and does not respond to any environmental stimulus. Cyclical sleep and awake states are maintained, and incontinence is present. Various factors such as tumor, vascular events, drug use and radiotherapy are responsible for the development of AM. A 12-year-old epileptic patient displayed AM and diphenylhydantoin toxicity (DPH). She seemed awake, was unable to speak or to understand, and had no movements with either spontaneous or noxious stimuli. Her serum DPH level was greater than 40 micrograms/ml. magnetic resonance imaging (MRI) showed mild cerebellar atrophy. All known causes of AM were excluded. The AM state in this patient was considered to be due to toxic DPH levels. She regained her motor and mental activity within two months after carbamazepine was administered to replace DPH. She was symptom-free when examined at the two-year follow-up. No similar adverse effect of DPH has been reported to date.
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