[go: up one dir, main page]
More Web Proxy on the site http://driver.im/ Skip to main content
Springer Nature Link
Log in

Akinetic mutism associated with bicingular lesions: Clinicopathological and functional anatomical correlates

  • Published:
European archives of psychiatry and neurological sciences Aims and scope Submit manuscript

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
£29.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (United Kingdom)

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Amyes EW, Nielsen JM (1955) Clinicopathologic study of the anterior cingulate region. Bull Los Angeles Neurol Soc 20:112–130

    Google Scholar 

  2. Baldessarini RJ, Tasy D (1979) Relationship of the actions of neuroleptic drugs to the pathophysiology of tardive dyskinesia. In: Smytkes IR, Bradhy RJ (eds) International review of neurobiology. Academic Press, NewYork

    Google Scholar 

  3. Barris WR, Schumann HR (1953) Bilateral anterior cingulate gyrus lesion: syndrome of the anterior cingulate gyri. Neurology (Minneap) 3:44–80

    Google Scholar 

  4. Björklund A, Lindwall O (1984) Dopamine-containing systems in the CNS. In: Handbook of chemical neuroanatomy, vol 2: Björklund A, Hökfelt T (eds) Classical transmitters in the CNS. Part I. Elsevier, Amsterdam New York Oxford, pp 55–123

    Google Scholar 

  5. Buge A, Escourolle R, Rancurel, Poisson M (1975) “Mutisme akinétique” et ramolissement bicingulaire. Rev Neurol 131:121–128

    Google Scholar 

  6. Cairns HWB, Oldfield RC, Pennybacker JB, Whitteridge D (1941) Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain 64:273–291

    Google Scholar 

  7. Cairns HWB (1952) Disturbances of consciousness with lesions of brainstem and diencephalon. Brain 75:109–145

    Google Scholar 

  8. Cravioto H, Silberman J, Feigin I (1960) A clinical and pathological study of akinetic mutism. Neurology (Minneap) 10:10–21

    Google Scholar 

  9. Daly DD, Love JG (1958) Akinetic mutism. Neurology 8:236–242

    Google Scholar 

  10. Denny-Brown D (1962) The basal ganglia and their relation to disorders of movement. Oxford University Press, London

    Google Scholar 

  11. Faris AA (1969) Limbic system infarction. A report of two cases. Neurology (Minneap) 19:91–96

    Google Scholar 

  12. Freemon FR (1971) Akinetic mutism and bilateral anterior cerebral artery occlusion. J Neurol Neurosurg Psychiatr 34:639–698

    Google Scholar 

  13. Fuxe K, Hökfelt T, Johansson O, Jonsson G, Lidbrink P, Ljungdahl A (1974) The origin of the dopamine nerve terminals in limbic and frontal cortex. Evidence for mesocortical dopamine neurons. Brain Res 82:349–355

    Google Scholar 

  14. Fuxe K, Agnati LF, Kalia M, Goldstein M, Anderson K, Härfstrand A (1985) Dopaminergic systems in the brain and pituitary. In: Flückinger E, Müller EE, Thomer MO (eds) The dopaminergic system. Springer, Berlin Heidelberg New York Tokyo, pp 11–25

    Google Scholar 

  15. Glowinski J, Tassin JP, Thierry AM (1984) The mesocorticoprefrontal dopaminergic neurons. Trends Neurosci 7:415–419

    Google Scholar 

  16. Hegedüs K, Németh G (1984) The adult form of subacute necrotizing encephalopathy. Surg Neurol 21:572–276

    Google Scholar 

  17. Jurgens U, Cramon D von (1982) On the role of the anterior cingulate cortex in phonation. Brain Long 15:234–248

    Google Scholar 

  18. Jonas S (1981) The supplementer motor region and speech emission. J Commun Dis 14:349–373

    Google Scholar 

  19. Jouvet M (1969) Coma and other disorders of consciousness. In: Vinken PJ, Bruyn GW (eds) Handbook of clinical neurology, vol III. Elsevier, Amsterdam, pp 62–79

    Google Scholar 

  20. Kemper TL, Romanul FCA (1967) State resembling akinetic mutism in basilar artery occlusion. Neurology (Minneap) 17:74–80

    Google Scholar 

  21. Laplane O, Talairach J, Meininger V, Bancaud J, Orgogozo JM (1977) Clinical consequences of corticectomies involving the supplementer motor area in man. J Neurol Sci 34:301–314

    Google Scholar 

  22. Lechi A, Pilleri G, Carreras M (1975) Akinetic mutism due to glioma of the midline. Arch Psychiatr Nervenkr 220:1–5

    Google Scholar 

  23. Lindwall O, Björklund A, Moore RY, Steneri J (1974) Mesencephalic dopamine neurons projecting to neocortex. Brain Res 81:325–331

    Google Scholar 

  24. Lindwall O, Björklund A, Divac I (1978) Organization of catecholamine neurons projecting to the frontal cortex in the rat. Brain Res 142:1–24

    Google Scholar 

  25. Ljungberg T, Ungerstedt U (1976) Sensory inattention produced by 6-hydroxydopamine-induced degeneration of ascending dopamine neurons in the brain. Exp Neurol 43:585–600

    Google Scholar 

  26. Marshall JF, Teitelbaum P (1977) New considerations in the neuropsychology of motivated behavior. In: Iversen LL, Iversen SD, Synder SH (eds) Handbook of psychopharmacology. Plenum Press, New York, pp 201–229

    Google Scholar 

  27. Marshall JF, Gotthelf T (1979) Sensory inattention in rats with 6-hydroxy-dopamine-induced degeneration of ascending dopaminergic neurons: apomorphine induced reversal of deficits. Exp Neurol 65:398–411

    Google Scholar 

  28. Maughi E, Mironi F, Saginario M, Valla S (1953) La sindrome del mutismo acinetico. G Psychiatr Neuropatol 87:239–244

    Google Scholar 

  29. Molnár L (1983) Blick- und Bewußtseinsstörungen bei Malazie der Brücke. In: Neumärker KJ (ed) Hirnstammläsionen. Neurologische, psychopathologische, morphologische und computertomographische Aspekte. Ferdinand Enke, Stuttgart, pp 164–168

    Google Scholar 

  30. Moore RY, Bloom FE (1978) Central catecholamine neuron systems: anatomy and physiology of the DA systems. Annu Rev Neurosci 1:129–169

    Google Scholar 

  31. Németh G, Hegedüs K, Molnár L (1986) Akinetic mutism and locked-in syndrome: the functional-anatomical differentiation. Funct Neurol 1:128–139

    Google Scholar 

  32. Nielsen JM, Jacobs LL (1951) Bilateral lesions of the anterior cingulate gyri. Report of a case. Bull Los Angeles Neurol Soc 16:231–234

    Google Scholar 

  33. Ogata J, Fikiyama K, Iwata Y (1966) Akinetic mutism in extensive cerebral softening. Clinical and pathological observation. Clin Neurol (Tokyo) 6:125–130

    Google Scholar 

  34. Plum F, Posner JB (1966) The diagnosis of stupor and coma. Davis, Philadelphia

    Google Scholar 

  35. Reuther R, Dorndorf W (1973) Ventrales Pons-Syndrom (akinetischer Mutismus) bei Verschluß der A. basilaris. Nervenarzt 44:419–423

    Google Scholar 

  36. Reznik M (1983) Neuropathology in seven cases of locked-in syndrome. J Neurol Sci 60:67–78

    Google Scholar 

  37. Ross ED, Stewart RM (1981) Akinetic mutism from hypothalamic damage: successful treatment with dopamine agonists. Neurology (Minneap) 31:1435–1439

    Google Scholar 

  38. Segarra IM (1970) Cerebral vascular disease and behavior. I. The syndrome of the mesencephalic artery (basilar artery bifurcation). Arch Neurol (Chicago) 22:408–418

    Google Scholar 

  39. Skultety FM (1968) Clinical and experimental aspects of akinetic mutism. Arch Neurol 19:1–14

    Google Scholar 

  40. Showers MIC (1959) The cingulate gyrus. Additional motor area and cortical anatomic regulator. J Comp Neurol 112:231–301

    Google Scholar 

  41. Tow PM, Whitty CWM (1953) Personality changes after operations of the cingulate gyrus in man. J Neurol Neurosurg Psychiatr 16:186–193

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurology and Psychiatry, University Medical School, H-4012, Debrecen, Hungary

    György Németh, Katalin Hegedüs & László Molnâr

Authors
  1. György Németh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katalin Hegedüs
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. László Molnâr
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Németh, G., Hegedüs, K. & Molnâr, L. Akinetic mutism associated with bicingular lesions: Clinicopathological and functional anatomical correlates. Eur Arch Psychiatr Neurol Sci 237, 218–222 (1988). https://doi.org/10.1007/BF00449910

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00449910

Key words

Search

Navigation