41. Types Of Brain Injury Vigilance and agitation for Frontal akinetic mutism. akinetic mutism is differentfrom the Minimally Responsive State because the lack of movement and http://www.biausa.org/Pages/types_of_brain_injury.html

Symptoms Coup-contre coup injury Diffuse Axonal Injury Second Impact Syndrome ... Open Head Injury A traumatic brain injury occurs when an outside force impacts the head hard enough to cause the brain to move within the skull or if the force causes the skull to break and directly hurts the brain. A direct blow to the head can be great enough to injure the brain inside the skull. A direct force to the head can also break the skull and directly hurt the brain. This type of injury can occur from motor vehicle crashes, firearms, falls, sports, and physical violence, such as hitting or striking with an object. A rapid acceleration and deceleration of the head can force the brain to move back and forth across the inside of the skull. The stress from the rapid movements pulls apart nerve fibers and causes damage to brain tissue. This type of injury often occurs as a result of motor vehicle crashes and physical violence, such as Shaken Baby Syndrome. Definition: Traumatic Brain Injury `Traumatic brain injury is an insult to the brain, not of a degenerative or congenital nature but caused by an external physical force, that may produce a diminished or altered state of consciousness, which results in an impairment of cognitive abilities or physical functioning. It can also result in the disturbance of behavioral or emotional functioning. These impairments may be either temporary or permanent and cause partial or total functional disability or psychosocial maladjustment. Adopted by the Brain Injury Association Board of Directors, February 22, 1986. This definition is not intended as an exclusive statement of the population served by the Brain Injury Association of America.

42. Transplantation - UserLogin First, the initial presentation of akinetic mutism with a brief episode ofblepharospasm akinetic mutism is a profoundly reduced conscious state but, http://www.transplantjournal.com/pt/re/transplantation/fulltext.00007890-2003041

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43. Transplantation - Abstract: Volume 75(7) April 15, 2003 P 1058-1060 OKT3 Neuroto OKT3 neurotoxicity presenting as akinetic mutism. Transplantation. 75(7)10581060,April 15, 2003. Pittock, Sean J. 1; Rabinstein, Alejandro A. 1; Edwards, http://www.transplantjournal.com/pt/re/transplantation/abstract.00007890-2003041

LWWOnline LOGIN eALERTS REGISTER ... Archive OKT3 neurotoxicity presenting as... ARTICLE LINKS: Fulltext PDF (905 K) OKT3 neurotoxicity presenting as akinetic mutism. Transplantation. 75(7):1058-1060, April 15, 2003. Pittock, Sean J. 1; Rabinstein, Alejandro A. 1; Edwards, Brooks S. 2; Wijdicks, Eelco F. M. 1 3 Abstract: Background. Muromonab-CD3 (OKT3), a mouse monoclonal antibody directed against human T lymphocytes, is a potent immunosuppressive agent used to reverse and more recently to prevent allograft rejection, mostly in cardiac transplant recipients. Neurotoxicity from OKT3 usually manifests itself as a transient aseptic meningitis and remains uncommon. Methods. The authors describe a dramatic neurologic syndrome after orthotopic heart transplant characterized by akinetic mutism, blepharospasm, anomic aphasia, and delirium. Results. Magnetic resonance imaging (MRI) showed meningeal enhancement and single-photon emission computed tomography (SPECT) showed markedly reduced tracer uptake. Discontinuation of OKT3 resulted in resolution of this neuropsychiatric syndrome and reversal of abnormalities on neuroimaging that coincided with normalization of CD3+ lymphocyte count. Conclusions. In the initial posttransplant period, it remains difficult to attribute encephalopathic signs to toxicity of immunosuppressive drugs. However, MRI and cerebral perfusion studies may help support the diagnosis. More precise characterization of the prevalence of OKT3-associated encephalopathy could come from prospective SPECT studies.

44. UAB Health System: Patient Stories - Chris Wilson akinetic mutism is a state in which a person is unspeaking (mute) andunmoving (akinetic). A person with akinetic mutism has sleepwaking cycles but, http://www.uab.edu/stories/wilson.html

DHTML Menu, (c)2004 Apycom Medicine That Touched My World Chris Wilson’s Story Chris Wilson had a dirt bike wreck in July 2004 that left him with a severe brain injury. A family man and a deputy sheriff for 10 years, Chris, determined to get back to his life, worked hard at rehab with help from the professionals at UAB's Spain Rehabilitation Center. Life Before the Accident Chris Wilson, a physically active man in his early 30s, didn't let anything slow him down - until he sustained a life-threatening brain injury in a dirt bike accident in 2004. A Jefferson County Sheriff's Deputy for over 10 years, Chris provided physical training for newly hired police and deputies. In the past, he had been on his college track team, and in the army's 20th Special Forces Group Airborne, "I jumped out of planes for a living," he quips. Chris and his wife Angela, a nurse, had been married almost nine years, had a three-year-old son and a second son on the way at the time of the accident. In this interview with Chris, his wife and some of his therapists from UAB's Spain Rehabilitation Center , we unfold the story of an accident that changed his life, and the teamwork that led him on the road to recovery.

45. AKINETIC MUTISM Abulia milder on spectrum of akinetic mutism, with reduced impulse to act, slowresponses (lack of initiative spontaneity) http://www.uwo.ca/cns/resident/pocketbook/approach/akineticmutism.htm

AKINETIC MUTISM aka Coma Vigil Definition State of consciousness with preserved awareness, retention of ability to move and speak but failure to do so (immobile and mute but eyes open, follows environment, but not respond to commands) - ie. no deficit in effectors of movement or speech (like a global apraxia of interaction) Localization 1. Frontal lobe - usually bilateral medial frontal (especially cingulate gyrus) 2. Basal ganglia - ventral striatum, globus pallidus 3. Fornix / limbic system 4. Thalamus - medial nuclei 5. Diffuse white matter disease (eg. leukoencephalopathy) Differential Diagnosis 2. Apathy - dull emotional tone, able to verbalize this lack of interest - both #1 and #2 are localized to bilateral medial frontal 3. Depression - flat affect, apathetic (see #2); ? left frontal or anterior temporal Catatonia - may have posturing and stereotypy, even bouts of excitement (can respond to benzodiazepines) 5. Extrapyramidal muteness - inability to act due to increased tone and akinesia (parkinsonism) - from basal ganglia disease (incl. neuroleptic malignant syndrome)

46. Tentative Anatomoclinical Classification (1941) under the name of akinetic mutism. It concerns those subjects in whom It would appear therefore that the syndrome of akinetic mutism may result http://sommeil.univ-lyon1.fr/articles/jouvet/hcn_69/p8.html

Coma and other disorders of consciousness Jouvet M. Handbook of Clinical Neurology Vol.3. P. J. Vinken and G. W. Bruyn , eds. North-Holland Publishing Company. Amsterdam,(1969) TABLE OF CONTENTS Introduction Physiopathological basis of coma (introductory remarks) Nervous structures necessary for consciousness Periodic physiological dissolution of consciousness: sleep and coma ... Tentative anatomoclinical classification FIGURES Select a figure Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PRINT Printable version MICHEL JOUVET Page of Michel Jouvet His articles on this server Tentative anatomoclinical classification By correlating the preceding classification with anatomical observations on our own cases and others described in the literature, we have been able to distinguish four main anatomoclinical stages in prolonged coma ( Fig.8 The reactive apathic hypoperceptive syndrome The reactive hyperpathic-hypertonic aperceptivity syndrome In all the cases, the lesion is similar. There is either massive cortical involvement (Denst et al. 1958) or diffuse degenerative changes in the white matter of the cerebral hemispheres. The brainstem is intact in the majority of cases (with the exception of the pyramidal fibres which frequently show signs of degeneration). The areactive apathic normotonic aperceptivity syndrome This group concerns cases of very deep coma in which survival is usually limited to a few weeks. Perceptivity is lost (P5). Nonspecific reactions are altered (R2-R3) as well as reaction to pain (D2-D3), but autonomic reactions are normal. In most cases, there is no definite hypertonicity. Patients described by Jefferson (1952) under the name of parasomnia, by French (1952) under the name of prolonged uncounsciousness, and by Cravioto et al. (1958), and Trillet (1961), present the same symptomatology. The lesion common to all these patients is one affecting the upper part of the brainstem (mesencephalic reticular formation), but in most cases, there were also associated lesions of the cortex or white matter. It appears that total or subtotal destruction of the reticular system is responsible for the more severe losses of reactivity.

47. Coma And Other Disorders Of Consciousness - Introduction akinetic mutism with an epidermoid cyst of the 3rd ventricle A clinical andpathologic study of akinetic mutism Neurology (Minneap.) 10 (1960) 1020. http://sommeil.univ-lyon1.fr/articles/jouvet/hcn_69/contents.html

Coma and other disorders of consciousness Jouvet M. Handbook of Clinical Neurology Vol.3. P. J. Vinken and G. W. Bruyn , eds. North-Holland Publishing Company. Amsterdam,(1969) TABLE OF CONTENTS Introduction Physiopathological basis of coma (introductory remarks) Nervous structures necessary for consciousness Periodic physiological dissolution of consciousness: sleep and coma ... Tentative anatomoclinical classification FIGURES Select a figure Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 PRINT Printable version MICHEL JOUVET Page of Michel Jouvet His articles on this server Introduction and of reactivity , will lead to another definition borrowed from psychophysiology. According to this definition, consciousness is that central nervous process which gives significance to a stimulus from the external environment. We can thus understand by consciousness that function of the nervous system which is concerned with the perceptual experience of information from the environment and from our own body (Alajouanine 1957). The multiple disintegration of consciousness observed in coma can therefore be defined as the absence, in the patient, of objective clinical (or paraclinical) signs of appreciation of his environment. It is this behavioural deficiency that the clinician explores by simple means: failure to rouse a comatose patient by calling his name or applying a painful stimulus.

48. 02-13 akinetic mutism represents the ‘emptying out’ of consciousness, a state in whichthere is not much point in anything. This talk will outline the columnar http://www.imprint-academic.demon.co.uk/T2000/02-13.html

Emotion Peri-Reticular Substrates of Emotion: The ‘Centrecephalon’ and Consciousness With the exception of work by Panksepp, Newman and Baars, and Damasio, there has been virtually no systematic work in consciousness theory on systems beneath the thalamus in terms of their critical participation in foundations for consciousness, although virtually everyone agrees that numerous reticular systems, particularly the core monoamine nuclei, are essential for consciousness. However, beyond notions of the ‘non-specific arousal’ functions supported in these core nuclei, the ventral brain gets very little attention and consciousness theory outside of the above noted authors. This talk will outline the columnar architecture and connectivities of PAG, its role in the organizing prototypes states of emotion, and the re-entry of PAG with the extended reticular thalamic activating system (ERTAS). At the end we will outline some potential implications of these connectivities for possible functional correlates of PAG networks that are just starting to be mapped. Over all, we will look at many lines of evidence that PAG should be conceptualized as a peri-reticular structure that has a foundational role in emotion, and in generating the meaningful organization of behavior by the brain through prototype emotional states. Cerebral Organization of Self, Two Types of Emotions and Consciousness

49. Akinetic Mutism As A Classification Criterion For The Diagnosis Of Creutzfeldt-J akinetic mutism has been anatomically divided into two forms the The aimof this study was to delimit the symptom of akinetic mutism in patients http://jnnp.bmjjournals.com/cgi/content/abstract/64/4/524

HOME HELP FEEDBACK SUBSCRIPTIONS ... TABLE OF CONTENTS Author Keyword(s) Vol Page [Advanced] This Article Full Text Full Text (PDF) Submit a response ... Citation Map Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal ... Cited by other online articles PubMed PubMed Citation Articles by Otto, A. Articles by Poser, S. J Neurol Neurosurg Psychiatry 524-528 ( April ) Akinetic mutism as a classification criterion for the diagnosis of Creutzfeldt-Jakob disease Anke Otto, Inga Zerr, Maria Lantsch, Kati Weidehaas, Christian Riedemann, Sigrid Poser Received 8 July 1997 and in revised form 30 September 1997 Accepted 3 October 1997 OBJECTIVES Among the classification criteria for the diagnosis of Creutzfeldt-Jakob disease, akinetic mutism is described as a symptom which helps to establish the diagnosis as possible or probable.

50. STATES RELATED TO OR CONFUSED WITH COMA -- Cartlidge 71 (Supplement 1): 18 -- Jo akinetic mutism was first described in patients thought to have suffered diencephalic akinetic mutism with an epidermoid cyst of the third ventricle. http://jnnp.bmjjournals.com/cgi/content/full/71/suppl_1/i18

HOME HELP FEEDBACK SUBSCRIPTIONS ... TABLE OF CONTENTS Author Keyword(s) Vol Page [Advanced] This Article Extract Full Text (PDF) Submit a response ... Alert me if a correction is posted Services Email this link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal ... Download to citation manager PubMed PubMed Citation Articles by Cartlidge, N. Related Collections Neurology in Practice Other Neurology J Neurol Neurosurg Psychiatry (Suppl 1) i18-i19 ( September ) STATES RELATED TO OR CONFUSED WITH COMA Niall Cartlidge Correspondence to: Dr Niall E F Cartlidge, Department of Neurology, Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK Introduction Top Introduction CONSCIOUSNESS STUPOR AKINETIC MUTISM Vegetative state Locked-in syndrome Catatonia Psychogenic coma References Neurologists are increasingly asked to see patients with acute neurological problems, many of whom have disorders of consciousness

51. Akinesia For example, a person in coma is akinetic. For another example, akinetic mutismis a condition in which a person is both mute and akinetic. http://www.psyweb.com/Glossary/akinesia.jsp

52. Access To Articles : Nature The end state is akinetic mutism, a kind of waking coma. Before people startedplaying with Predictors, akinetic mutism was very rare, http://www.nature.com/nature/journal/v436/n7047/full/436150a.html

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53. News@nature The end state is akinetic mutism, a kind of waking coma. The fact that someindividuals descend into akinetic mutism whereas others do not just http://www.nature.com/news/2005/050704/full/436150a.html

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54. The Journal Of Trauma: Injury, Infection, And Critical Care - UserLogin akinetic mutism. Neurology. 1958;8238242. Context Link. 12. French JD.Brain lesions associated with prolonged unconsciousness. Arch Neurol Psychiat. http://www.jtrauma.com/pt/re/jtrauma/fulltext.00005373-200503000-00032.htm

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55. Arousal And Gating In Neurology Of Impaired Consciousness attend hyperkinetic mutism, akinetic mutism, or temporal lobe seizures. such as the crude form of attention in akinetic mutism; the uncontrolled, http://www-users.med.cornell.edu/~jdvicto/scpl00.html

The Role of Arousal and "Gating" Systems in the Neurology of Impaired Consciousness Nicholas D. Schiff and Fred Plum Journal of Clinical Neurophysiology 17, 438-452 (2000) Abstract Related publication: emphasis on neurobiology Related publication: emphasis on therapeutic strategies Publications related to consciousness and brain dynamics Return to publications list

56. Vol.8 - 6. Diagnosis, Treatment And Care Of VCJD Patients Return to top of page 1 IBD3 tab 9 2 Dysaesthesiae unpleasant abnormal sensations3 akinetic mutism - paralysis and inability to speak 4 IBD3 tab 9 http://www.bseinquiry.gov.uk/report/volume8/chaptee2.htm

Quick navigation menu Home The Inquiry Report Download report as PDF Evidence Contact details Order a copy Help Search Volume Specific - Index List of Acronyms Who's Who Volume 8: Variant CJD 6. Diagnosis, treatment and care of vCJD patients Symptoms of vCJD On 21 March 1996, the CJDSU circulated to all neurologists in the UK a description of the clinical and pathological features of the new phenotype. The clinical features of the new phenotype of CJD described in the circular were as follows: An early age of onset or death (average 27.6 years, range 18-41 years). A prolonged duration of illness (average 13.1 months, range 7.5-24 months). A predominantly psychiatric presentation including anxiety, depression, withdrawal and progressive behavioural changes. The first evidence of neurological involvement in four patients was dysaesthesiae in the limbs and/or face. Development of a cerebellar syndrome with problems with gait and limb muscle coordination after a period of weeks or months. Development of forgetfulness and memory disturbance, often late in the clinical course, which progressed to severe cognitive impairment and a state of akinetic mutism

57. Vol.8 - 3. Establishment Of The CJD Surveillance Unit 4 akinetic mutism impairment of voluntary muscle movement, including the lossof speech 5 EEG - electroencephalogram - the recording of electrical http://www.bseinquiry.gov.uk/report/volume8/chapterc.htm

Quick navigation menu Home The Inquiry Report Download report as PDF Evidence Contact details Order a copy Help Search Volume Specific - Index List of Acronyms Who's Who Volume 8: Variant CJD 3. Establishment of the CJD Surveillance Unit Review of the CJDSU by the Allen Committee 4 April 1991 1 July 1991 22 February 1993 19 July 1995 The work of the CJDSU was reviewed by the MRC Allen Committee, chaired by Professor Ingrid Allen, which met four times between 1991 and 1995. This Committee was established on the basis of concerns raised by Professor Allen at a meeting of the MRC Coordinating Committee for Research on Spongiform Encephalopathies in Man (The Murray Committee; see vol. 2: Science ) in October 1990. She considered that the design of Dr Will's study could mean that atypical features of dementia, like those exhibited by patients developing CJD as a result of treatment with human growth hormone, might fall outside the study. A Clinical Subcommittee was therefore established to coordinate and facilitate studies relating to the epidemiological monitoring and neuropathological definition of human SEs, to monitor patients at risk of iatrogenic infection and to apply new methodologies and technologies to refine the definition and improve diagnosis of SEs. The Allen Committee had powers to co-opt relevant experts when necessary. Dr Will was a co-opted member of the group.

58. Arch Neurol -- Abstract: Akinetic Mutism In A Bone Marrow Transplant Recipient F We describe a case of akinetic mutism associated with diffuse cerebralleukoencephalopathy, which developed in a bone marrow transplant recipient following http://archneur.ama-assn.org/cgi/content/abstract/44/4/414

Select Journal or Resource JAMA Archives of Dermatology Facial Plastic Surgery Family Medicine (1992-2000) General Psychiatry Internal Medicine Neurology Ophthalmology Surgery Student JAMA (1998-2004) JAMA CareerNet For The Media Meetings Peer Review Congress Vol. 44 No. 4, April 1987 Featured Link E-mail Alerts ARTICLE Article Options Send to a Friend Readers Reply Submit a reply Similar articles in this journal Literature Track Add to File Drawer Download to Citation Manager PubMed citation Articles in PubMed by Devinsky O Rottenberg DA Articles that cite this article Contact me when this article is cited Akinetic mutism in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A positron emission tomographic and neuropathologic study O. Devinsky, W. Lemann, A. C. Evans, J. R. Moeller and D. A. Rottenberg We describe a case of akinetic mutism associated with diffuse cerebral leukoencephalopathy, which developed in a bone marrow transplant recipient following total-body irradiation and amphotericin B chemoprophylaxis. A

59. APPROACH TO A PATIENT IN COMA akinetic mutism is similar to the vegetative state, except, these patients havelittle spontaneous or induced movements. Catatonic patients are mute with http://www.neuro.mcg.edu/amurro/coma/

APPROACH TO A PATIENT IN COMA Anthony Murro, M.D. Department of Neurology Medical College of Georgia Augusta, Georgia 3091 Contents Introduction How to identify coma States related to coma Clinical evaluation ... Outline - Evaluation of coma Introduction Coma is a challenging medical emergency. There is a broad differential diagnosis, complex physical exam, and the urgent need to diagnose and treat potentially reversible disease. This article describes an approach to the diagnosis and treatment of a patient in coma. How to identify coma A patient with coma has eyes closed, has no sleep-wake cycle and remains unconscious despite vigorous stimulation. Unconsciousness implies that the patient has no observable evidence of awareness of self or surroundings. Coma is caused by diffuse bilateral brain, diencephalic or brainstem disease. The coma state should be distinguished from stupor, the persistent vegetative state, locked-in-syndrome, akinetic mutism, catatonia, pseudocoma and brain death. Unlike the patient in coma, a patient with stupor temporarily regains consciousness following vigorous stimulation. If consciousness does not return within 2-4 weeks, the comatose patient enters a persistent vegetative state. Unlike coma, these patients have sleep-wake cycles, spontaneous movements, and eye opening. The patient might persist in the vegetative state for months or years. Locked-in-patients are mute and have no limb, facial or horizontal eye movements. These patients communicate through vertical eye movements and blinking. Brainstem stroke is a common cause of locked-in-syndrome.

60. ¥Ø¿ýºK­n10-2 Baclofeninduced Reversible akinetic mutism Current diagnosis of baclofen-inducedakinetic mutism is based on clinical history and the findings of EEG. http://www.neuro.org.tw/mag4-2.htm

²Ä¤Q¤@¤G¨÷²Ä¤G´ÁºK­n Spinal Muscular Atrophy: From Animal Model to Potential Treatments Ming-Shiun Tsai , Sue-Hong Wang , Li-Kai Tsai , and Hung Li Institute of Molecular Biology, Academia Sinica, Taipei, Taiwan; Jen-Teh Junior College of Medicine, Nursing and Management, Miaoli, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan Abstract- Spinal muscular atrophy (SMA) is an autosomal recessive disease characterized by degeneration of the anterior horn cells of the spinal cord leading to muscular paralysis and atrophy. SMA is the second commonest genetic cause of death in childhood affecting approximately 1 in 10,000 live births, but no effective treatment is currently available. Due to gene deletions, mutations, or conversions, the telomeric copy of the survival of motor neuron (SMN) gene is abnormal in more than 96% of patients with clinically typical SMA. The identification of SMN-interacting protein strongly suggests that it is involved in the assembly of the spliceosome, processing of pre-mRNA splicing, transcription, and metabolism of ribosomal RNA. Mouse models of human SMA have been established through a combination of knockout and transgenic techniques. These SMA-like mice genotypically and phenotypically mimic SMA

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