A case with bilateral thalamic infarction manifesting mutism – Cerebral blood flow and neural fibers evaluation
Open Access
- 2 March 2021
- journal article
- Published by Scientific Scholar in Surgical Neurology International
- Vol. 12, 84
- https://doi.org/10.25259/sni_874_2020
Abstract
Background: Acute bilateral thalamic infarction is rare, and occlusion of the artery of percheron (AOP) may be one of its reasons. AOP occlusion results in an acute disturbance of consciousness, but mutism due to AOP occlusion is rare. We described a mutism patient with bilateral thalamic infarction presumably due to AOP occlusion. We also performed cerebral blood flow (CBF) evaluation by N-isopropyl-p-[123I]-iodoamphetamine single-photon emission computed tomography (123I-IMP-SPECT) as well as neural fiber evaluation by diffusion tensor tractography, discussing the mechanism of mutism. Case Description: A 92-year-old woman presented a gradual deterioration of consciousness. Diffusion-weighted images revealed high-intensity areas at the bilateral thalami, and we diagnosed AOP occlusion. We administered a recombinant tissue plasminogen activator. On day 14, her Glasgow Coma Scale score was 11 (E4V1M6), and she did not present any apparent paresis. She was mute but cognitively alert, although she could communicate by nodding or facial expression. 123I-IMP-SPECT showed CBF increase in the bilateral cerebellum and CBF decrease in the infarcted bilateral thalami and frontal lobes. Diffusion tensor tractography revealed the bilateral dentatothalamo-cortical tracts (DTCs). However, the tracts terminated at the parieto-occipital cortex, but not at the frontal cortex. She still had mutism on day 30. Conclusion: We reported the bilateral thalamic infarction patient presumably due to AOP occlusion, who presented mutism. The discontinuity of the bilateral DTCs resulted in her mutism, and our results supported the hypothesis that the cerebellum plays a significant role in uttering, associated with the bilateral DTCs.This publication has 17 references indexed in Scilit:
- Clinical Spectrum of Artery of Percheron Infarct: Clinical–Radiological CorrelationsJournal of Stroke and Cerebrovascular Diseases, 2014
- A child with mutism after bilateral thalamic infarctionJournal of Clinical Neuroscience, 2011
- Thalamic infarct presenting as catastrophic life-threatening event in an older adultAging Clinical and Experimental Research, 2011
- Artery of Percheron Infarction: Imaging Patterns and Clinical SpectrumAmerican Journal of Neuroradiology, 2010
- Akinetic mutism--not comaAge and Ageing, 2008
- The contribution of the cerebellum to speech production and speech perception: Clinical and functional imaging dataThe Cerebellum, 2007
- Cerebellar Mutism after Basilar Artery Occlusion —Case Report—Neurologia medico-chirurgica, 1998
- Akinetic mutism with bithalamic infarction. Neurophysiological correlatesJournal of the Neurological Sciences, 1996
- Paramedian thalamic and midbrain infarcts: Clinical and neuropathological studyAnnals of Neurology, 1981
- The anatomy of the arterial supply of the human thalamus and its use for the interpretation of the thalamic vascular pathologyZeitschrift für Neurologie, 1973