Akinetic Mutism Following Bilateral Infarcts Associated with a Mitral Valve Papillary Fibroelastoma

Akinetic mutism is a rare but important clinical syndrome characterised by a profound decrease in goal-directed behaviour and speech output, yet with preservation of consciousness. This report describes the case of a 58-year-old male with a background of hypertension, alcohol use disorder, smoking, and MTHFR C677T homozygosity who experienced two ischaemic strokes within weeks of each other. The initial infarct involved the right thalamus, posterior putamen, external capsule, and subcortical anterior frontal lobe. Approximately five weeks later, he developed a second stroke in the left hemisphere, eventually leading to the identification of a mitral valve mass consistent with a papillary fibroelastoma. Following surgical resection of this mass, the patient demonstrated severe reductions in spontaneous movement and speech in a pattern consistent with akinetic mutism. He ultimately improved with rehabilitative measures and the initiation of a stimulant medication. This case highlights the intricate relationship between bilateral frontal-subcortical network injuries and the development of akinetic mutism.