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Frontal Disconnection for Treating Mild Malformation of Cortical Development with Oligodendroglial Hyperplasia in Epilepsy (MOGHE) in the Frontal Lobe

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Akinetic mutism without a structural prefrontal lesion.

Asli Demirtas-Tatlidede¹, Sara Z Bahar, Hakan Gurvit

¹Department of Neurology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey. aslidemirtas@yahoo.com

Cognitive and Behavioral Neurology : Official Journal of the Society for Behavioral and Cognitive Neurology

|July 2, 2013

Summary

Akinetic mutism, a condition of profound apathy and lack of action, can result from cerebellar infarction causing bifrontal hypoperfusion. This case highlights how cerebellar damage can lead to widespread frontal lobe dysfunction.

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Area of Science:

Neurology
Neuroscience
Neuroimaging

Background:

Akinetic mutism is a neuropsychiatric disorder characterized by apathy and absence of purposeful motor and verbal output, typically following bilateral medial frontal subcortical circuit damage.
Understanding the neuroanatomical underpinnings of akinetic mutism is crucial for diagnosis and treatment.

Observation:

A 59-year-old woman presented with sudden-onset akinetic mutism.
Neuroimaging revealed an acute left superior cerebellar infarction and a prior left inferior parietal infarct.
Electroencephalogram showed bilateral frontal delta-wave activity.

Findings:

Technetium-99m hexamethylpropyleneamine oxime single-photon emission computed tomography (Tc-HMPAO SPECT) demonstrated bifrontal hypoperfusion, more pronounced on the right, correlating with akinetic mutism.
The cerebellar infarction likely induced contralateral frontal diaschisis, leading to bilateral frontal dysfunction due to interconnected lesion effects.

Implications:

This case illustrates a potential mechanism for akinetic mutism secondary to cerebellar infarction, emphasizing the role of interconnected brain networks.
Cerebellar lesions can precipitate frontal lobe dysfunction and akinetic mutism through diaschisis, impacting patient care and rehabilitation strategies.