Akinetic mutism

The akinetic mutism is a neurological syndrome characterized by a severe disturbance of the drive. In this case, the person is awake and has no paralysis. He moved himself not ( akinesia ), does not speak ( mutism ) and also shows no emotion, as this lacks any drive. Perception and memory are usually not affected.

Causes

• Damage to the frontal lobe or cingulate gyrus, for example, by a two-sided occlusion of the anterior cerebral artery ( stroke) or a traumatic brain injury
• Pressure effect on the diencephalon, especially by tumors (eg, choroid plexus papilloma ) or hydrocephalus
• Later stage spongiform encephalopathies such as Creutzfeldt- Jakob disease.

Diagnostics

For accurate assessment and clarification of the cause of the syndrome magnetic resonance imaging of the head as well as the derivation of an electroencephalogram are necessary, often also an examination of the cerebrospinal fluid to exclude an inflammatory disease.

This applies in particular to delineate a Apallic syndrome, a locked-in syndrome or catatonia.

Forecast

The further development is dependent on the causative disorder. Significant recoveries are therefore even after months still possible, for example, after treatment of hydrocephalus ( " water on the brain " ) or in the context of recovery from a traumatic brain injury.

Neuropsychological aspects

Neuropsychological findings indicate that the cingulate gyrus anterior, which is affected by this disease, an important role in willing relevance: This brain region forms the front part of a gyrus, like a sickle is located on the inner surface of the cortex, and many authors are expected to forebrain. Besides their importance in the selection of actions it is an interface between emotion and cognition.

Antonio Damasio dealt for years with such patients. A patient who awoke from this state, reported on her enigmatic month-long silence and immobility. Contrary to what a casual observer might have thought her spirit had not been locked up like a prison. Rather was not much left of her mind. She had no memory of certain experiences during the long period of silence. She had never felt fear or anxiety never felt the desire to communicate. Damasio stresses that this patient had not suffered from it all. There was no emotional reactions. What she lacked was obviously any drive, any motivation to act. As she said herself, it was not because they did not understand what was going on around them himself. It was rather that she wanted to do or say anything. Francis Crick moved from this account to the conclusion that the woman had lost her will.

Swell

• Neuropsychological syndrome