Akinetic mutism and mixed transcortical aphasia following left thalamo–mesencephalic infarction

A 54-year-old man developed somnolent akinetic mutism and acute mixed transcortical aphasia following a left thalamo-mesencephalic infarction. He also exhibited behavioural changes, namely apathy, slowness, lack of spontaneity, disinhibition, perseveration, gait apraxia and incontinence consistent with frontal lobe dysfunction. Presumably the akinetic mutism and language dysfunction were due to the thalamic stroke. All the manifestations could be related to interruption of the frontal-subcortical circuitry.

[1]  N. Nagaratnam,et al.  Language Dysfunction in White Matter: Lesions Without Significant Hemiparesis , 1996 .

[2]  J. Bogousslavsky.  Frontal stroke syndromes. , 1994, European neurology.

[3]  M S Mega,et al.  Akinetic mutism: disconnection of frontal-subcortical circuits. , 1997, Neuropsychiatry, neuropsychology, and behavioral neurology.

[4]  L. Weisberg.  Thalamic hemorrhage , 1986, Neurology.

[5]  E. Kokmen,et al.  The paramedian diencephalic syndrome: a dynamic phenomenon. , 1987, Stroke.

[6]  J. W. Brown.  Language, cognition and the thalamus. , 1974, Confinia neurologica.

[7]  M. Mesulam,et al.  Frontal lobe dysfunction following infarction of the left-sided medial thalamus. , 1991, Archives of neurology.

[8]  R W BARRIS,et al.  Bilateral Anterior Cingulate Gyrus Lesions , 1953, Neurology.

[9]  K. Heilman,et al.  Transcortical aphasia from ischaemic infarcts of the thalamus: a report of two cases. , 1982, Journal of neurology, neurosurgery, and psychiatry.

[10]  Mixed transcortical aphasia without anatomic isolation of the speech area. , 1990, Stroke.

[11]  F. Gray,et al.  Bilateral infarction of the anterior cingulate gyri and of the fornices Report of a case , 1981, Journal of the Neurological Sciences.

[12]  J. Bogousslavsky,et al.  Manic delirium and frontal-like syndrome with paramedian infarction of the right thalamus. , 1988, Journal of neurology, neurosurgery, and psychiatry.

[13]  E. Ross,et al.  Left medial parietal lobe and receptive language functions , 1980, Neurology.

[14]  J. Mohr,et al.  Thalamic hemorrhage and aphasia , 1975, Brain and Language.

[15]  Clinical,et al.  Paramedian thalamic and midbrain infarcts: Clinical and neuropathological study , 1981, Annals of neurology.

[16]  T. Kemper,et al.  State resembling akinetic mutism in basilar artery occlusion , 1967, Neurology.

[17]  N. Nagaratnam,et al.  Syndrome of downward gaze paralysis, amnesia and hypersomnolence. , 1989, Postgraduate medical journal.

[18]  T. Yuasa,et al.  Mutism developing after bilateral thalamo‐capsular lesions by neuro‐Behçet disease , 1995, Acta neurologica Scandinavica.

[19]  A. Lang,et al.  Hypoxic‐ischemic damage of the basal ganglia case reports and a review of the literature , 1990, Movement disorders : official journal of the Movement Disorder Society.

[20]  J. Cummings,et al.  Frontal-subcortical circuits and human behavior. , 1993, Journal of psychosomatic research.

[21]  H. Cravioto,et al.  A clinical and pathologic study of akinetic mutism , 1960, Neurology.

[22]  R. Strub,et al.  Frontal lobe syndrome in a patient with bilateral globus pallidus lesions. , 1989, Archives of neurology.

[23]  C. Randt,et al.  Diagnosis of Stupor and Coma. , 1967 .

[24]  J. Segarra.  Cerebral vascular disease and behavior. I. The syndrome of the mesencephalic artery (basilar artery bifurcation). , 1970, Archives of neurology.

[25]  N. Geschwind.  Isolation of the Speech Area , 1968 .

[26]  B. Levin,et al.  Dorsal column stimulation , 1980, Neurology.

[27]  N. Nagaratnam,et al.  Acute mixed transcortical aphasia following an infarction in the left putamen , 1998 .

[28]  Nielsen Jm,et al.  Bilateral anterior cingulate gyrus lesions; report of case. , 1953 .

[29]  E. Kaplan,et al.  Longitudinal neuropsychological report of aphasia following left-subcortical hemorrhage , 1982, Brain and Language.

[30]  D. S. Bell.  Speech functions of the thalamus inferred from the effects of thalamotomy. , 1968, Brain : a journal of neurology.