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

  • György Németh
  • Katalin Hegedüs
  • László Molnâr
Article

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.

Key words

Akinetic mutism Cingulate gyri Mesolimbocortical dopaminergic system 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Amyes EW, Nielsen JM (1955) Clinicopathologic study of the anterior cingulate region. Bull Los Angeles Neurol Soc 20:112–130Google Scholar
  2. 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, NewYorkGoogle Scholar
  3. 3.
    Barris WR, Schumann HR (1953) Bilateral anterior cingulate gyrus lesion: syndrome of the anterior cingulate gyri. Neurology (Minneap) 3:44–80Google Scholar
  4. 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 55–123Google Scholar
  5. 5.
    Buge A, Escourolle R, Rancurel, Poisson M (1975) “Mutisme akinétique” et ramolissement bicingulaire. Rev Neurol 131:121–128Google Scholar
  6. 6.
    Cairns HWB, Oldfield RC, Pennybacker JB, Whitteridge D (1941) Akinetic mutism with an epidermoid cyst of the 3rd ventricle. Brain 64:273–291Google Scholar
  7. 7.
    Cairns HWB (1952) Disturbances of consciousness with lesions of brainstem and diencephalon. Brain 75:109–145Google Scholar
  8. 8.
    Cravioto H, Silberman J, Feigin I (1960) A clinical and pathological study of akinetic mutism. Neurology (Minneap) 10:10–21Google Scholar
  9. 9.
    Daly DD, Love JG (1958) Akinetic mutism. Neurology 8:236–242Google Scholar
  10. 10.
    Denny-Brown D (1962) The basal ganglia and their relation to disorders of movement. Oxford University Press, LondonGoogle Scholar
  11. 11.
    Faris AA (1969) Limbic system infarction. A report of two cases. Neurology (Minneap) 19:91–96Google Scholar
  12. 12.
    Freemon FR (1971) Akinetic mutism and bilateral anterior cerebral artery occlusion. J Neurol Neurosurg Psychiatr 34:639–698Google Scholar
  13. 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 82:349–355Google Scholar
  14. 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 11–25Google Scholar
  15. 15.
    Glowinski J, Tassin JP, Thierry AM (1984) The mesocorticoprefrontal dopaminergic neurons. Trends Neurosci 7:415–419Google Scholar
  16. 16.
    Hegedüs K, Németh G (1984) The adult form of subacute necrotizing encephalopathy. Surg Neurol 21:572–276Google Scholar
  17. 17.
    Jurgens U, Cramon D von (1982) On the role of the anterior cingulate cortex in phonation. Brain Long 15:234–248Google Scholar
  18. 18.
    Jonas S (1981) The supplementer motor region and speech emission. J Commun Dis 14:349–373Google Scholar
  19. 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 62–79Google Scholar
  20. 20.
    Kemper TL, Romanul FCA (1967) State resembling akinetic mutism in basilar artery occlusion. Neurology (Minneap) 17:74–80Google Scholar
  21. 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 34:301–314Google Scholar
  22. 22.
    Lechi A, Pilleri G, Carreras M (1975) Akinetic mutism due to glioma of the midline. Arch Psychiatr Nervenkr 220:1–5Google Scholar
  23. 23.
    Lindwall O, Björklund A, Moore RY, Steneri J (1974) Mesencephalic dopamine neurons projecting to neocortex. Brain Res 81:325–331Google Scholar
  24. 24.
    Lindwall O, Björklund A, Divac I (1978) Organization of catecholamine neurons projecting to the frontal cortex in the rat. Brain Res 142:1–24Google Scholar
  25. 25.
    Ljungberg T, Ungerstedt U (1976) Sensory inattention produced by 6-hydroxydopamine-induced degeneration of ascending dopamine neurons in the brain. Exp Neurol 43:585–600Google Scholar
  26. 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 201–229Google Scholar
  27. 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 65:398–411Google Scholar
  28. 28.
    Maughi E, Mironi F, Saginario M, Valla S (1953) La sindrome del mutismo acinetico. G Psychiatr Neuropatol 87:239–244Google Scholar
  29. 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 164–168Google Scholar
  30. 30.
    Moore RY, Bloom FE (1978) Central catecholamine neuron systems: anatomy and physiology of the DA systems. Annu Rev Neurosci 1:129–169Google Scholar
  31. 31.
    Németh G, Hegedüs K, Molnár L (1986) Akinetic mutism and locked-in syndrome: the functional-anatomical differentiation. Funct Neurol 1:128–139Google Scholar
  32. 32.
    Nielsen JM, Jacobs LL (1951) Bilateral lesions of the anterior cingulate gyri. Report of a case. Bull Los Angeles Neurol Soc 16:231–234Google Scholar
  33. 33.
    Ogata J, Fikiyama K, Iwata Y (1966) Akinetic mutism in extensive cerebral softening. Clinical and pathological observation. Clin Neurol (Tokyo) 6:125–130Google Scholar
  34. 34.
    Plum F, Posner JB (1966) The diagnosis of stupor and coma. Davis, PhiladelphiaGoogle Scholar
  35. 35.
    Reuther R, Dorndorf W (1973) Ventrales Pons-Syndrom (akinetischer Mutismus) bei Verschluß der A. basilaris. Nervenarzt 44:419–423Google Scholar
  36. 36.
    Reznik M (1983) Neuropathology in seven cases of locked-in syndrome. J Neurol Sci 60:67–78Google Scholar
  37. 37.
    Ross ED, Stewart RM (1981) Akinetic mutism from hypothalamic damage: successful treatment with dopamine agonists. Neurology (Minneap) 31:1435–1439Google Scholar
  38. 38.
    Segarra IM (1970) Cerebral vascular disease and behavior. I. The syndrome of the mesencephalic artery (basilar artery bifurcation). Arch Neurol (Chicago) 22:408–418Google Scholar
  39. 39.
    Skultety FM (1968) Clinical and experimental aspects of akinetic mutism. Arch Neurol 19:1–14Google Scholar
  40. 40.
    Showers MIC (1959) The cingulate gyrus. Additional motor area and cortical anatomic regulator. J Comp Neurol 112:231–301Google Scholar
  41. 41.
    Tow PM, Whitty CWM (1953) Personality changes after operations of the cingulate gyrus in man. J Neurol Neurosurg Psychiatr 16:186–193Google Scholar

Copyright information

© Springer-Verlag 1988

Authors and Affiliations

  • György Németh
    • 1
  • Katalin Hegedüs
    • 1
  • László Molnâr
    • 1
  1. 1.Department of Neurology and PsychiatryUniversity Medical SchoolDebrecenHungary

Personalised recommendations