Cases reported "Brain Damage, Chronic"

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1/11. Operculum syndrome in childhood: a rare cause of persistent speech disturbance.

    An infant is described who developed operculum syndrome during an acute encephalitic illness. Presenting symptoms were cortical pseudobulbar palsy and focal seizures of facial origin. Persistent mutism--with normal language comprehension and orofacial motor disturbance--were the main neurological sequelae. Similarities between this case and other permanent or transient causes of cortical pseudobulbar palsy are discussed, as well as the possible relationship with certain types of childhood language disorders.
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ranking = 1
keywords = mutism
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2/11. Biopercular lesions and acquired mutism in a young patient.

    A 13-year-old patient developed complete mutism and buccofacial apraxia following toxic vasculitis due to a yellow scorpion sting. Language functions were preserved. A CT scan disclosed mainly biopercular infarcts. It is suggested that the lost control of vocalization and speech is associated with biopercular lesions and that a preserved right opercular region can take over this function in the presence of damage to homologous left opercular region.
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ranking = 5
keywords = mutism
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3/11. Treating organic abulia with bromocriptine and lisuride: four case studies.

    Abulia refers to an impairment of will, or the inability to initiate behaviour and action. There are reports of successful treatment of akinetic mutism, the most severe form of abulia, with bromocriptine. Four case studies are presented describing the successful treatment of abulia at a lesser severity than akinetic mutism with bromocriptine. Abulia was caused by brain damage due to alcohol in two cases, Wilson's disease and basal ganglia infarct in one each. Maximum bromocriptine dose varied from 25-70 mg. All improved considerably. Withdrawal or reduction of medication in three produced deterioration. The prescription of a neuroleptic drug had a similar effect in the fourth. One patient with a previous history developed a depressive relapse and so the drug was withdrawn and lisuride introduced. This produced a similar improvement. These cases highlight the value of identifying the syndrome of organic abulia and suggest that dopamine agonists may have a place in its treatment, though controlled studies are needed.
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ranking = 25.598829745617
keywords = akinetic mutism, akinetic, mutism
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4/11. Unexpected recovery of functional communication following a prolonged period of mutism post-head injury.

    A case is presented of a seven-year-old female who showed an unexpected recovery of functional communication skills following a prolonged period of traumatic mutism subsequent to a severe closed head injury. The patient initially presented as comatose. A period of mutism subsequent to the coma extended for ten months. Following this protracted period of mutism the child demonstrated rapid and unexpected recovery of functional communication skills, despite the persistence of higher level language deficits. The findings of a neurological assessment, neuroradiological assessment and battery of speech/language tests are described. The present case is discussed in light of the existing literature on recovery from paediatric head trauma.
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ranking = 7
keywords = mutism
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5/11. akinetic mutism associated with bicingular lesions: clinicopathological and functional anatomical correlates.

    The clinical symptoms and neuropathological findings of three patients suffering from akinetic mutism were summarized. The patients showed almost absolute mutism and immobility and were unable to communicate in any way. The neurological signs varied from case to case. The pathological features common to all of the cases were bilateral lesions of the rostral part of the anterior cingulate gyri which overlapped onto the neighboring supplementary motor area, while differing as regards other damage. With the help of more recent neurobiochemical findings we tried to analyze the pathomechanism of akinetic mutism on the basis of the structures damaged. There seems to be an anatomic correspondence between the mesolimbocortical dopaminergic system and the circumscribed bilateral lesions of the medial prefrontal cortex. The study suggests that damage of the mesolimbocortical dopaminergic terminal fields in the anteromedial frontal cortex is essential for this specific type of akinetic mutism.
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ranking = 59.178779977773
keywords = akinetic mutism, akinetic, mutism
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6/11. Behavioral effects of damage to the right insula and surrounding regions.

    A severe multimodal neglect syndrome, mutism, oral apraxia and ideomotor apraxia for the right hand suddenly developed in a right-handed male following a right hemisphere (central) stroke. Neuropathologic examination showed an ischemic infarction involving the whole right insula, adjacent white matter, and the inner cortical surface of the right fronto-temporo-parietal operculum. The left hemisphere was spared. It is suggested that damage to the right insula (a polymodal convergence area), and the adjacent white matter may lead to severe neglect. Our case also demonstrates a clear dissociation between dominance for handedness and dominance for kinesthetic motor engrams.
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ranking = 1
keywords = mutism
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7/11. Development of akinetic mutism and hyperphagia after left thalamic and right hypothalamic lesions.

    A case of childhood post-traumatic akinetic mutism is presented. The patient showed a hyperphagic condition while recovering from akinetic mutism. He had lesions in the left interlaminal nucleus of the thalamus, right globus pallidus, and right dorsomedial nucleus of the hypothalamus. Laboratory data indicated slightly disturbed hypothalamic functions. In general, akinetic mutism can be seen with bilateral destructive lesions, while hyperphagia may occur after destruction of dorsomedial hypothalamic nucleus, but it is very rare. This is the first reported case of akinetic mutism caused by a unilateral lesion.
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ranking = 144.47674660739
keywords = akinetic mutism, akinetic, mutism
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8/11. Asymmetric catalepsy after right hemisphere stroke.

    We describe the appearance of left hemineglect and striking cataleptic posturing, more prominent in left-sided extremities, in a patient without psychiatric illness. neuroimaging demonstrated a large posterior right hemisphere infarct involving the parietal, occipital, and temporal lobes, the insula, and caudate. Additional movement abnormalities that comprise the full catatonia syndrome were absent, including stereotypy, mannerisms, ambitendency, automatic obedience, mutism, negativism, and echopraxia. catatonia has been reported to be produced by lesions of diverse etiology affecting the frontal lobe, limbic system, diencephalon, or basal ganglia. In these cases, catalepsy has been manifest only rarely, and motor signs that are present are generally bilateral. This case demonstrates that asymmetric catalepsy can be produced by right hemisphere stroke, and provides partial support for earlier clinical literature relating catalepsy and the parietal lobe.
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ranking = 1
keywords = mutism
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9/11. A serial computerized tomographic study of the interval form of CO poisoning.

    Serial computerized tomography (CT) was performed to quantitatively characterize cerebral changes in 1 case of the interval form of carbon monoxide poisoning. The patient was comatose for 2 days, regained consciousness for 8 days, and then developed akinetic mutism. During the remission period, a low-density area in the cerebral white matter was observed to enlarge progressively. These results suggest that the demyelination of the cerebral white matter progressed throughout the interval period. A correlation between changes in CT abnormalities and clinical presentation is described.
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ranking = 18.059593325924
keywords = akinetic mutism, akinetic, mutism
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10/11. The many faces of acquired neurologic mutism in childhood.

    Acquired neurologic mutism in childhood is a complex phenomenon occurring in various neurologic conditions with different etiologies. We illustrate its clinical heterogeneity as reflected in a wide range of concomitant behavioral features by presenting 4 children with acquired neurologic mutism. Neuropsychologic examinations revealed differential patterns of defective or preserved phonation, orofacial movements, communicative behavior, and linguistic functions. We propose that detailed neuropsychologic analysis contributes to descriptions of the evolution of the speech impairment beyond the mute phase and the long-term disability. A framework for the clinical evaluation of children is therefore presented.
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ranking = 6
keywords = mutism
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