Abstract
A 77-year-old woman was reported, who showed akinetic mutism after an attack of cerebral thrombosis. The patient was admitted to the hospital complaining anorexia, followed by a development of left facial palsy, left hemiparesis and akinetic mutism, which was characterized by opening eyes to calling, gazing observers, following the movement of objects, escape from the painful stimuli, and forced grasp. Consciousness disturbance was gradually deepened and she died on the 52nd hospital day.
Electroencephalograms showed slow α waves (8 to 9 cps) at the parieto-occipital region prior to onset of akinetic mutism, slow δ waves (3 cps) superimposed on the α to θ waves (7 to 8 cps) 3 weeks after the development of mutism, and large slow waves (1 to 2 cps) and irregular α waves (10 cps) on the left hemisphere in the terminal stage.
Autopsy showed almost complete obstruction of the siphon of the right internal carotid artery by the organized thrombus, and there were extensive softening at the right precentral gyrus, cingulate gyrus, corpus callosum, hippocampal gyrus and reticular formation of thalamus and hypothalamus. Thus, our case showed extensive lesions encompassing all of 3 main areas of cerebral lesions in the akinetic mutism; that is (1) cerebrum, (2) frontal lobe (cingulate gyrus and corpus callosum) and (3) thalamus and hypothalamus.
