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Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report

This paper presents a case in whom a differential diagnosis of akinetic mutism with a disorder of consciousness was made using diffusion tensor tractography (DTT). A 69-year-old female patient was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage produ...

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Autores principales: Byun, Dong Hyun, Jang, Sung Ho
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914078/
https://www.ncbi.nlm.nih.gov/pubmed/35280207
http://dx.doi.org/10.3389/fnhum.2022.778347
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author Byun, Dong Hyun
Jang, Sung Ho
author_facet Byun, Dong Hyun
Jang, Sung Ho
author_sort Byun, Dong Hyun
collection PubMed
description This paper presents a case in whom a differential diagnosis of akinetic mutism with a disorder of consciousness was made using diffusion tensor tractography (DTT). A 69-year-old female patient was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage produced by the subarachnoid hemorrhage. She exhibited impaired consciousness with a Coma Recovery Scale-Revised score of 13 until 1 month after onset. Her impaired consciousness recovered slowly to a normal state according to the Coma Recovery Scale-Revised (23 points: full score) at 7 weeks after onset. On the other hand, she exhibited the typical clinical features of akinetic mutism (no spontaneous movement [akinesia] or speech [mutism]). On the DTT performed at 1-month, the upper, and lower dorsal ascending reticular activating systems, which are related to a disorder of consciousness, showed an almost normal state. In contrast, the prefronto-caudate and prefronto-thalamic tracts, which are related to akinetic mutism, showed severe injuries. These DTT results suggested that the patient's main clinical features were not a disorder of consciousness but akinetic mutism. Therefore, DTT for the ascending reticular activating system, and the prefronto-caudate and prefronto-thalamic tracts could provide additional evidence for a differential diagnosis of DOC and AM at the early stages of stroke.
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spelling pubmed-89140782022-03-12 Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report Byun, Dong Hyun Jang, Sung Ho Front Hum Neurosci Human Neuroscience This paper presents a case in whom a differential diagnosis of akinetic mutism with a disorder of consciousness was made using diffusion tensor tractography (DTT). A 69-year-old female patient was diagnosed with subarachnoid hemorrhage, intraventricular hemorrhage, and intracerebral hemorrhage produced by the subarachnoid hemorrhage. She exhibited impaired consciousness with a Coma Recovery Scale-Revised score of 13 until 1 month after onset. Her impaired consciousness recovered slowly to a normal state according to the Coma Recovery Scale-Revised (23 points: full score) at 7 weeks after onset. On the other hand, she exhibited the typical clinical features of akinetic mutism (no spontaneous movement [akinesia] or speech [mutism]). On the DTT performed at 1-month, the upper, and lower dorsal ascending reticular activating systems, which are related to a disorder of consciousness, showed an almost normal state. In contrast, the prefronto-caudate and prefronto-thalamic tracts, which are related to akinetic mutism, showed severe injuries. These DTT results suggested that the patient's main clinical features were not a disorder of consciousness but akinetic mutism. Therefore, DTT for the ascending reticular activating system, and the prefronto-caudate and prefronto-thalamic tracts could provide additional evidence for a differential diagnosis of DOC and AM at the early stages of stroke. Frontiers Media S.A. 2022-02-25 /pmc/articles/PMC8914078/ /pubmed/35280207 http://dx.doi.org/10.3389/fnhum.2022.778347 Text en Copyright © 2022 Byun and Jang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Human Neuroscience
Byun, Dong Hyun
Jang, Sung Ho
Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report
title Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report
title_full Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report
title_fullStr Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report
title_full_unstemmed Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report
title_short Differential Diagnosis of Akinetic Mutism and Disorder of Consciousness Using Diffusion Tensor Tractography: A Case Report
title_sort differential diagnosis of akinetic mutism and disorder of consciousness using diffusion tensor tractography: a case report
topic Human Neuroscience
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8914078/
https://www.ncbi.nlm.nih.gov/pubmed/35280207
http://dx.doi.org/10.3389/fnhum.2022.778347
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