J Clin Neurol.  2011 Dec;7(4):223-226. 10.3988/jcn.2011.7.4.223.

Leukoencephalopathy and Akinetic Mutism in a Married Couple: A Probable Association with Oriental Medicine

• Lee IS
• Kim YD
• Kwon SY
• Kim JS

• KMID: 2179008
• DOI: http://doi.org/10.3988/jcn.2011.7.4.223

Abstract

BACKGROUND
Oriental medicines have been associated with severe psychiatric, neurological, and other adverse medical events. These medicines occasionally cause a typical reversible toxic encephalopathy, but most such cases are not recognized because these adverse events are complex and are associated with other systemic signs and symptoms.
CASE REPORT
We describe a married couple with rapid progressive cognitive impairment and akinetic mutism after taking the same oriental medicines on the same day. Brain magnetic resonance images of the couple showed typical leukoencephalopathy in the periventricular white matter and basal ganglia regions, bilaterally.
CONCLUSIONS
The development of neurobehavioral symptoms and toxic leukoencephalopathy in both patients following the ingestion of oriental medicines is suggestive of a cause-and-effect association, although such a relationship needs to be verified.

Keyword

oriental medicine; toxic leukoencephalopathy; akinetic mutism

MeSH Terms

Akinetic Mutism
Basal Ganglia
Brain
Eating
Humans
Leukoencephalopathies
Magnetic Resonance Spectroscopy
Medicine, East Asian Traditional
Neurotoxicity Syndromes

Figure

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  Fig. 1 Case 1; the wife. A: T2-weighted and fluid attenuated inversion recovery (FLAIR) magnetic resonance imaging (MRI) showing hyperintense lesions in the periventricular and deep white matter, and basal ganglia, bilaterally. B: Follow-up MRI performed 1 month after admission revealed more extensive symmetrical high signal intensities in T2-weighted and FLAIR images. C: The lesion had a high signal intensity on diffusion-weighted images, with a low signal intensity on the apparent-diffusion-coefficient map.

• 

  Fig. 2 Case 2; the husband. A: Similar to the magnetic resonance imaging (MRI) findings of case 1, the brain MRI revealed hyperintense lesions in the white matter bilaterally, on T2-weighted and fluid attenuated inversion recovery images. B: Follow-up MRI performed 1 month after admission revealed more extensive hyperintense lesions.

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