Abstract
We describe a 68-year-old female with persistent atrial fibrillation, who presented with characteristic ocular signs and akinetic mutism due to embolic occlusion of the basilar artery.
She was admitted to our hospital because of disturbed consciousness and immobility of the left extremities. After recovery of consciousness disturbance, she was apathetic and lack of spontaneity, and she was diagnosed as having akinetic mutism. Her left eye was slightly abducted, and right eye was mydriatic with corectopia.
Cerebral angiography examined at admission revealed occlusions of the right posterior cerebral artery and the right superior cerebellar artery at their origins. Follow-up angiography performed 22 days after admission showed reopening of the occulded arteries.
CT revealed low density area in the bilateral thalami and right cerebral peduncle. Moreover, MRI demonstrated low signal intensity areas restricted to the paramedian area of bilatral thalami and tegmentum of the midbrain by horizontal section, and characteristic butterfly-shaped lesion by coronal section.
We suspected that responsible lesions for the development of neurologic signs were present in the right nucleus of Edinger-Westphal, the left oculomotor nucleus, the rostral interstitial nucleus of MLF, and bilateral thalami. These lesions were caused by flow derangement of the paramedian thalamic artery due to embolic occlusion of the top of the basilar artery.
