Fatih DEMİR, Aylin AKÇALI, Gülsüm ÇOMRUK

Bilateral anterior serebral arter infarktına bağlı akinetik mutizm olgusu

Akinetik mutizm, nukleus caudatus veya anterior singulat girusun bilateral lezyonlarından kaynaklanan klinik bir tablodur. İstemli hareket, konuşma ve emosyonel ifadeler tamamen ortadan kalkmış olmasına rağmen hastanın gözleri açık ve uyanık görünümdedir. Elli dört yaşında erkek hasta acil servise konuşamama, yürüyememe, anlamsız bakma şikayetleriyle kabul edilmiştir. Nörolojik muayenesinde hasta uyanık görünmesine rağmen iletişim kurulamamıştır. Sol üst ve alt ekstremitelerde daha belirgin dört ekstremitede tonus artışı izlenmiştir. Takipte hastanın ağız çevresinde istemsiz hareketleri gözlenmiştir. Difüzyon ağırlıklı kraniyal manyetik rezonans görüntülemede her iki anterior serebral arter (ACA) sulama alanında parasagittalde giral tarzda akut infarkt ile uyumlu görünüm izlenmiştir. Klinik pratikte psikiyatrik tablolarla ayırıcı tanıda olabilecek bu olgu nadir görülen bilateral ACA infarktına bağlı akinetik mutizm olarak sunulmaya değer görülmüştür.

Akinetic mutism cases due to bilateral anterior cerebral artery infarct

Akinetic mutism is a clinical status from the bilateral lesion of nucleus caudatus or anterior cingulate gyrus. Although voluntary motions, speech, and emotional responses are completely gone, the patient may be awake with eyes opened. A 54-year-old man was brought to the emergency clinic with complaints of meaningless stares and inability to speak and walk. On neurological examination, the patient was unresponsive, although he looked awake. The tonus was increased on all extremities, especially on the left arm and leg. On his follow-up, involuntary tiny motions around his mouth were observed. Bilateral anterior cerebral artery infarct was observed on diffusion-weighted magnetic resonance imaging. This case, which may be distinguished from psychiatric charts in clinical practice, is considered to be presented as akinetic mutism due to a rare bilateral ACA infarct.

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