Akinetic Mutism following Spontaneous Subarachnoid Hemorrhage: A Case Report

Yoon, Seong Min; Park, Cheol Wan; Chun, Young Il; Kim, Woo Kyung

Abstract

Akinetic mutism (AM) is a rare complication of spontaneous subarachnoid hemorrhage (SAH). It is characterized by mutism and general hypokinesis in a patient superficially fully awake in that the eyes remain open and follow objects. Most common cause of AM in patients with SAH is secondary infarction in the distal anterior cerebral artery (DACA) territory. Sometimes post-SAH hydrocephalus has also been implicated in a delayed form of AM because of disruption of dopaminergic pathway. We report a case of 64-year-old woman who presented with sudden bursting headache without neurologic deficit. She was referred from the other hospital with a diagnosis of spontaneous SAH on head computed tomography (CT) which showed high density on sylvian, interhemispheric fissures and basal cistern. We performed computed tomographic cerebral angiography (CTA) and trans-femoral catheter cerebral angiography (TFCA), that revealed no definitive intracranial aneurysm, arterial dissection, or other vascular abnormality of the SAH. During admission period, she developed mutism and motor weakness of all limbs without spontaneous movement. We performed brain magnetic resonance (MR) image and RI cisternography. Also we prescribed levodopa. On the 33th hospital day, she had neurological recovery with drowsy mentality and grade 4 weakness of all limbs, but she was observed to suddenly develop general weakness and became cardiac arrest on the 55th hospital day. Efforts to resuscitate her failed, no more treatment could not be applied. In our case, we couldn't find infarction in the DACA terriority, midbrain or cerebellum except communicating hydrocephalus. This case may alert neurosurgeon to recognize the possibility of such rare complication after spontaneous SAH.