Akinetic Mutism and Parkinsonism after Multiple Shunt Failure: Case Report and Literature Review^[*]

Introduction

Akinetic mutism (AM) is typically a transient disorder that occurs primarily after posterior fossa tumor resection. In addition to the usual and typical clinical signs of recurrent obstructive hydrocephalus, AM is also a related, infrequent, and profound complication.

Our article presents another case of complete akinetic mutism associated to parkinsonism following multiple procedures for obstructive hydrocephalus caused by a dorsal midbrain lesion. We will also discuss the pathophysiology and relevant treatment.

^* This article was originally published online in Central European Neurosurgery on March 28, 2011 (DOI:10.1055/s-0030-1270475)

• References

• 1 Aidi S, Elalaoui-Faris M, Benabdeljlil M , et al. Akinetic mutism and progressive supranuclear palsy-like syndrome after the shunt of an obstructive hydrocephalus. Successful treatment with bromocriptine: 2 cases [Article in French]. Rev Neurol (Paris) 2000; 156 (4) 380-383
• 2 Alexander MP. Chronic akinetic mutism after mesencephalic-diencephalic infarction: remediated with dopaminergic medications. Neurohabil Neurol Repair 2001; 15 (2) 151-156
• 3 Anderson B. Relief of akinetic mutism from obstructive hydrocephalus using bromocriptine and ephedrine. Case report. J Neurosurg 1992; 76: 152-155
• 4 Barrer SJ, Schut L, Bruce DA. Global rostral midbrain dysfunction secondary to shunt malfunction in hydrocephalus. Neurosurgery 1980; 7: 322-325
• 5 Berger L, Gauthier S, Leblanc R. Akinetic mutism and parkinsonism associated with obstructive hydrocephalus. Can J Neurol Sci 1985; 12: 255-258
• 6 Bergsneider M, Peacock WJ, Mazziotta JC , et al. Beneficial effect of siphoning in treatment of adult hydrocephalus. Arch Neurol 1999; 56: 1224-1229
• 7 Cantini R, Ferrito G, Lutzemberger L , et al. Parkinsonian syndrome in the course of aqueductal stenosis hydrocephalus. Ital J Neurol Sci 1988; 9: 603-606
• 8 Cinalli G, Sainte-Rose C, Simon I , et al. Sylvian aqueduct syndrome and global rostral midbrain dysfunction associated with shunt malfunction. J Neurosurg 1999; 90: 227-236
• 9 Crutchfield JS, Sawaya R, Meyers CA , et al. Postoperative mutism in neurosurgery. Report of two cases. J Neurosurg 1994; 81: 115-121
• 10 Esposito A, Demeurisse G, Alberti B , et al. Complete mutism after midbrain periaqueductal gray lesion. Neuroreport 1999; 10: 681-685
• 11 Frim DM, Ogily C. Mutism and cerebellar dysarthria after brain stem surgery: case report. Neurosurgery 1995; 36: 854-857
• 12 Ildan F, Tuna M, Erman T , et al. The evaluation and comparison of cerebellar mutism in children and adults after posterior fossa surgery: report of two adult cases and review of the literature. Acta Neurochir (Wien) 2002; 144 (5) 463-473
• 13 Jürgens U. The role of periaqueductal grey in vocal behaviour. Behav Brain Res 1994; 62: 107-117
• 14 Kim SM, Rhee JJ, Lee SJ , et al. Akinetic mutism responsive to bromocriptine following subdural hematoma evacuation in a patient with hydrocephalus. Case report. Neurol Med Chir (Tokyo) 2007; 47: 419-423
• 15 Lee KS, Kwon OY, Lee L , et al. A case of akinetic mutism caused by volume change of cerebral ventricles (Korean, with English abstact). J Korean Neurol Assoc 2002; 20: 414-417
• 16 Lin KL, Wang HS, Chou ML , et al. Role of cavum septum pellucidum in akinetic mutism of hydrocephalic children. Pediatr Neurol 1997; 16 (2) 156-159
• 17 Messert B, Henke TK, Langheim W. Syndrome of akinetic mutism associated with obstructive hydrocephalus. Neurology 1966; 16: 635-649
• 18 Moser A, Freyberger HJ, Brückmann H , et al. Akinetic mutism in decompensated triventricular hydrocephalus. Fortschr Neurol Psychiatr 1995; 63 (6) 248-251
• 19 Pang D, Altschuler E. Low-pressure hydrocephalic state and viscoelastic alterations in the brain. Neurosurgery 1994; 35: 643-656
• 20 Psarros T, Zouros A, Coimbra C. Bromocriptine-responsive akinetic mutism following endoscopy for ventricular neurocysticercosis. J Neurosurg 2003; 99: 397-401
• 21 Saper CB. Function of the locus coeruleus. Trends Neurosci 1987; 10: 343-344
• 22 Tokunaga H, Shigeto H, Inamura T , et al. A case of severe parkinsonism induced by failure of ventriculo-peritoneal shunt for aqueductal stenosis [Article in Japanese]. Rinsho Shinkeigaku 2003; 43 (7) 427-430
• 23 Ungerstedt U. Functional dynamics of central monoamine pathways. In: Schmitt FO, Worden FG, eds. The Neurosciences Third Study Program Cambridge. Mass: MIT Press; 1974: 979-988
• 24 Watahiki Y, Narita S, Kurahashi K , et al. Akinetic mutism from recurrent hydrocephalus: successful treatment with levodopa, bromocriptine, and trihexyphenidyl. No To Shinkei 1987; 39: 977-982